Minosse Claudia, Biliotti Elisa, Lapa Daniele, Rianda Alessia, Marchili Mauro, Luzzitelli Ilaria, Capobianchi Maria Rosaria, McPhee Fiona, Garbuglia Anna Rosa, D'Offizi Gianpiero
Laboratory of Virology, "Lazzaro Spallanzani" National Institute for Infectious Diseases, IRCCS, 00149 Rome, Italy.
Hepatology and Infectious Diseases Unit, "Lazzaro Spallanzani" National Institute for Infectious Diseases IRCCS, 00149 Rome, Italy.
Pathogens. 2020 Oct 11;9(10):832. doi: 10.3390/pathogens9100832.
Genotype 3 (GT3) is responsible for most European autochthonous hepatitis E virus (HEV) infections. This study analyzed circulating genotypes and GT3 subtypes in the Lazio region, Italy, between 2011 and 2019, as well as their pathogenic characteristics. Of the 64 evaluable HEV GT3 patient-derived sequences, identified subtypes included GT3f ( = 36), GT3e ( = 15), GT3c ( = 9), GT3a ( = 1) and three unsubtyped GT3 sequences. GT3c strains were similar to Dutch sequences (96.8-98.1% identity), GT3e strains showed high similarity (96.8%) with a United Kingdom sequence, while the most related sequences to GT3f Italian strains were isolated in France, Belgium and Japan. One sequence was closely related to another Italian strain isolated in raw sewage in 2016. The liver functioning test median values for 56 evaluable GT3 patients were: alanine aminotransferase (ALT), 461 (range 52-4835 U/L); aspartate aminotransferase (AST), 659 (range 64-6588 U/L); and total bilirubin, 3.49 (range 0.4-33 mg/dL). The median HEV RNA viral load for 26 evaluable GT3 patients was 42,240 IU/mL (range 5680-895,490 IU/mL). Of the 37 GT3 patients with available clinical information, no correlation was observed between HEV clinical manifestations and GT3 subtype. HEV symptoms were comparable among GT3c/e/f patients across most analyzed categories except for epigastric pain, which occurred more frequently in patients with HEV GT3e (75%) than in patients with GT3c (50%) or GT3f (19%) ( = 0.01). Additionally, patients with HEV GT3c exhibited significantly higher median international normalized ratio (INR) than patients with GT3e and GT3f ( = 0.033). The severity of GT3 acute hepatitis E was not linked to HEV RNA viral load or to the GT3 subtype.
3型基因型（GT3）是导致大多数欧洲本土戊型肝炎病毒（HEV）感染的原因。本研究分析了2011年至2019年间意大利拉齐奥地区循环的基因型和GT3亚型，以及它们的致病特征。在64个可评估的源自HEV GT3患者的序列中，鉴定出的亚型包括GT3f（n = 36）、GT3e（n = 15）、GT3c（n = 9）、GT3a（n = 1）以及三个未分型的GT3序列。GT3c毒株与荷兰序列相似（同一性为96.8 - 98.1%），GT3e毒株与一个英国序列显示出高度相似性（96.8%），而与GT3f意大利毒株最相关的序列是在法国、比利时和日本分离得到的。一个序列与2016年在未经处理的污水中分离出的另一个意大利毒株密切相关。56名可评估的GT3患者的肝功能测试中位数分别为：丙氨酸转氨酶（ALT）461（范围为52 - 4835 U/L）；天冬氨酸转氨酶（AST）659（范围为64 - 6588 U/L）；总胆红素3.49（范围为0.4 - 33 mg/dL）。26名可评估的GT3患者的HEV RNA病毒载量中位数为42,240 IU/mL（范围为5680 - 895,490 IU/mL）。在37名有可用临床信息的GT3患者中，未观察到HEV临床表现与GT3亚型之间存在相关性。除上腹部疼痛外，在大多数分析类别中，GT3c/e/f患者的HEV症状具有可比性，上腹部疼痛在HEV GT3e患者中出现的频率（75%）高于GT3c患者（50%）或GT3f患者（19%）（P = 0.01）。此外，HEV GT3c患者的国际标准化比值（INR）中位数显著高于GT3e和GT3f患者（P = 0.033）。GT3急性戊型肝炎的严重程度与HEV RNA病毒载量或GT3亚型无关。
