Chronic Disease Management Center, Youan Hospital, Capital Medical University, Beijing, China.
The Second Department of Liver Disease Center, Youan Hospital, Capital Medical University, Beijing, China.
Adv Exp Med Biol. 2023;1417:215-226. doi: 10.1007/978-981-99-1304-6_15.
Hepatitis E virus (HEV) infections are the most common cause of acute hepatitis, but they can also take a chronic course. There is no specific therapy for acute hepatitis, and current treatment is supportive. Choosing ribavirin as the first-line therapy for chronic HEV is advisable, especially immunosuppressed individuals. Moreover, ribavirin therapy in the acute phase of infection provides major benefits for those at high risk of acute liver failure (ALF)/acute-on-chronic liver failure (ACLF). Pegylated interferon α has been used successfully for treatment of hepatitis E but is associated with major side effects. Cholestasis is one of the most common, but devastating, manifestations in hepatitis E. Current therapy for HEV aims to treat symptoms. Therapy generally involves several measures, such as vitamins, albumin, and plasma for supporting treatment, symptomatic treatment for cutaneous pruritus, ursodeoxycholic acid, Obeticholic acid, S-adenosylmethionine, etc. for removing jaundice. HEV infection during pregnancy and patients with underlying liver disease may develop liver failure. For these patients, active monitoring, standard care, and supportive treatment are the foundations. Ribavirin has successfully been used to prevent liver transplantation (LT). Prevention and treatment of complications are important for treatment of liver failure. Liver support devices are intended to support liver function until such time as native liver function recovers, or until LT. LT is widely considered as irreplaceable and definitive treatment for liver failure, particularly for patients who do not improve with supportive measures to sustain life.
戊型肝炎病毒（HEV）感染是急性肝炎的最常见原因，但也可呈慢性病程。急性肝炎目前尚无特效疗法，主要为支持治疗。选择利巴韦林作为慢性 HEV 的一线治疗药物是合理的，尤其适用于免疫抑制个体。此外，在感染的急性期进行利巴韦林治疗，对那些有发生急性肝衰竭（ALF）/慢加急性肝衰竭（ACLF）高危风险的患者具有重要获益。聚乙二醇干扰素α已成功用于治疗戊型肝炎，但与严重副作用相关。胆汁淤积是戊型肝炎最常见的但具破坏性的表现之一。目前针对 HEV 的治疗旨在缓解症状。治疗通常包括几个措施，如支持治疗的维生素、白蛋白和血浆，针对皮肤瘙痒的对症治疗，熊去氧胆酸、奥贝胆酸、S-腺苷甲硫氨酸等治疗黄疸。妊娠期间的 HEV 感染和基础肝病患者可能会发生肝功能衰竭。对于这些患者，积极监测、标准护理和支持治疗是基础。利巴韦林已成功用于预防肝移植（LT）。预防和治疗并发症对于肝功能衰竭的治疗非常重要。肝脏支持设备旨在支持肝功能，直至恢复正常或进行 LT。LT 被广泛认为是肝功能衰竭治疗的不可或缺和确定治疗方法，尤其是对于那些通过维持生命的支持措施无法改善的患者。
