Turk J Gastroenterol. 2022 Jul;33(7):615-624. doi: 10.5152/tjg.2022.21493.
Seroepidemiology, risk factors to hepatitis E virus exposure, and prevalence of hepatitis E virus viremia have not yet been investigated among patients under immunosuppression or with liver disease that are high risk for infection in Turkey.
In this cross-sectional study, 292 consecutive serum samples from renal transplant recipients, allogeneic hematopoietic stem cell transplant recipients, patients with acute hepatitis, and patients with chronic hepatitis C were prospectively collected in a ter- tiary university hospital. Sera were tested for hepatitis E virus immunoglobulin G/immunoglobulin M and hepatitis E virus ribonucleic acid using commercial enzyme-linked immunosorbent assay and in-house nested polymerase chain reaction with Sanger sequencing, respectively. Sociodemographic, clinical, laboratory data, and risk factors were collected using a questionnaire and hospital database. Multiple logistic regression analysis was employed to identify independent predictors for anti-hepatitis E virus seropositivity.
Among all patients, only 2 patients (1 renal transplant recipient and 1 patient with acute hepatitis) were identified as having hepatitis E virus genotype 3 viremia. Hepatitis E virus viremia rate was 0.6% in whole group. These patients showed no signs of chronic hepatitis E virus infection for 6 months and were spontaneously seroconverted 6 months after enrollment. Anti-hepatitis E virus IgG was positive in 29 patients yielding a hepatitis E virus seroprevalence of 9.9%. Older age (adjusted odds ratio: 1.03, 95% CI, 1.00-1.06; P = .022) and eating undercooked meat (adjusted odds ratio: 3.11, 95% CI, 1.08-8.92; P = .034) were independent risk factors to anti- hepatitis E virus seropositivity in all patients. Similarly, multiple logistic regression analysis demonstrated that age (adjusted odds ratio: 1.03, 95% CI, 0.99-1.07, P = .058) and eating undercooked meat (adjusted odds ratio: 5.77, 95% CI, 1.49-22.25, P = .011) were indepen- dent risk factors for anti-hepatitis E virus IgG positivity in the liver disease subgroup consisting of acute hepatitis and chronic hepatitis C patients.
The hepatitis E virus seroprevalence rate was high (9.9%), despite low viremia rate (0.6%) in high-risk patients. The emer- gence of hepatitis E virus genotype 3 might indicate a serious problem for these patients. Future investigations are needed to elucidate foodborne transmission routes of hepatitis E virus in Turkey.
在土耳其，针对接受免疫抑制治疗或患有肝病的高风险感染患者，尚未对其进行血清流行病学、戊型肝炎病毒暴露风险因素以及戊型肝炎病毒血症的流行情况研究。
在这项横断面研究中，我们前瞻性地在一所三级大学医院采集了 292 例连续的肾移植受者、异基因造血干细胞移植受者、急性肝炎患者和慢性丙型肝炎患者的血清样本。使用商业酶联免疫吸附试验和内部巢式聚合酶链反应（Sanger 测序）分别检测血清中的戊型肝炎病毒免疫球蛋白 G/免疫球蛋白 M 和戊型肝炎病毒 RNA。使用问卷和医院数据库收集社会人口统计学、临床和实验室数据以及风险因素。采用多因素逻辑回归分析确定抗戊型肝炎病毒血清阳性的独立预测因素。
在所有患者中，仅有 2 例患者（1 例肾移植受者和 1 例急性肝炎患者）被确定为戊型肝炎病毒 3 型病毒血症。全组戊型肝炎病毒血症率为 0.6%。这些患者在 6 个月内未出现慢性戊型肝炎病毒感染迹象，并在入组后 6 个月自发出现血清转换。29 例患者抗戊型肝炎病毒 IgG 阳性，戊型肝炎病毒血清流行率为 9.9%。年龄较大（调整后的优势比：1.03，95%可信区间，1.00-1.06；P =.022）和食用未煮熟的肉（调整后的优势比：3.11，95%可信区间，1.08-8.92；P =.034）是所有患者抗戊型肝炎病毒血清阳性的独立危险因素。同样，多因素逻辑回归分析表明，年龄（调整后的优势比：1.03，95%可信区间，0.99-1.07，P =.058）和食用未煮熟的肉（调整后的优势比：5.77，95%可信区间，1.49-22.25，P =.011）是急性肝炎和慢性丙型肝炎患者亚组抗戊型肝炎病毒 IgG 阳性的独立危险因素。
尽管高危患者的病毒血症率较低（0.6%），但戊型肝炎病毒血清流行率较高（9.9%）。戊型肝炎病毒 3 型的出现可能对这些患者构成严重威胁。需要进一步的研究来阐明土耳其戊型肝炎病毒的食源性传播途径。
