Pneumology, Lungenklinik Hemer, Hemer, Germany.
Private University Witten/Herdecke, Witten, Germany.
Pneumologie. 2024 Jun;78(6):400-408. doi: 10.1055/a-2291-0560. Epub 2024 Apr 24.
The causes of diaphragmatic paresis are manifold. An association between neuralgic amyotrophy (NA) and hepatitis E virus (HEV) infection has been reported. We wondered about the prevalence of diaphragmatic disfunction and hepatitis E infection in our clinic.
From July 1st, 2020 to August 31st, 2023, patients presenting with diaphragmatic dysfunction and simultaneous clinical symptoms of an acute NA, or a history of NA, as well as patients with previously unexplained diaphragmatic dysfunction were examined for HEV infection.
By August 31st, 2023, 13 patients with diaphragmatic dysfunction and HEV infection were diagnosed (4 women, 9 men). Mean age was 59 ± 10 years. Liver values were normal in all patients. The median latency to diagnosis was five months (range: 1-48 months); nine patients, 4 of them with typical symptoms of NA, presented with acute onset three patients showed bilateral diaphragmatic dysfunction. All patients had a positive IgG immunoblot. Seven patients, three with NA, had an elevated hepatitis E IgM titer and six of them also a positive IgM immunoblot. In all cases, O2C hepatitis genotype 3 was identified. In eight cases, all those with a high IgG titer >125, the O2 genotype 1 was also detected.
NA that shows involvement of the phrenic nerve resulting in diaphragmatic dysfunction and dyspnoea, may be associated with HEV infection. The observation of 13 patients with diaphragmatic dysfunctions and HEV infection within a period of three years indicates a high number of undetected HEV-associated diaphragmatic dysfunction in the population, especially in the absence of NA symptoms. Therefore, even in diaphragmatic dysfunction without NA symptoms and causative damaging event, HEV infection should be considered, as it may represent a subform of NA with only phrenic nerve involvement. Therapy of HEV-associated diaphragmatic dysfunction in the acute phase is an open question. In view of the poor prognosis for recovery, antiviral therapy should be discussed. However, no relevant data are currently available.
膈肌麻痹的原因多种多样。据报道，神经痛性肌萎缩（NA）与戊型肝炎病毒（HEV）感染之间存在关联。我们想了解我们诊所中膈肌功能障碍和戊型肝炎感染的流行情况。
从 2020 年 7 月 1 日至 2023 年 8 月 31 日，对出现膈肌功能障碍且同时具有急性 NA 的临床症状或 NA 病史的患者，以及先前原因不明的膈肌功能障碍患者，进行 HEV 感染检查。
截至 2023 年 8 月 31 日，诊断出 13 例膈肌功能障碍合并 HEV 感染的患者（4 名女性，9 名男性）。平均年龄为 59 ± 10 岁。所有患者的肝功能值均正常。中位诊断潜伏期为 5 个月（范围：1-48 个月）；9 例患者（其中 4 例有典型的 NA 症状）急性起病，3 例表现为双侧膈肌功能障碍。所有患者的 IgG 免疫印迹均为阳性。7 例患者（其中 3 例有 NA）的 HEV IgM 滴度升高，其中 6 例的 IgM 免疫印迹也为阳性。所有病例均鉴定出 O2C 基因型 3。在 8 例患者中，所有 IgG 滴度 >125 的患者均检测到 O2 基因型 1。
累及膈神经导致膈肌功能障碍和呼吸困难的 NA 可能与 HEV 感染有关。在三年内观察到 13 例膈肌功能障碍合并 HEV 感染的患者表明，人群中未检测到的与 HEV 相关的膈肌功能障碍数量较多，尤其是在没有 NA 症状的情况下。因此，即使在没有 NA 症状和病因性损伤事件的膈肌功能障碍中，也应考虑 HEV 感染，因为它可能代表仅累及膈神经的 NA 亚型。急性期 HEV 相关膈肌功能障碍的治疗是一个悬而未决的问题。鉴于恢复预后较差，应讨论抗病毒治疗。然而，目前尚无相关数据。
