Infectious Diseases Department, Faculty of Medicine, University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania.
Infectious Diseases Department, National Institute for Infectious Diseases, Bucharest, Romania.
J Med Virol. 2024 Oct;96(10):e70001. doi: 10.1002/jmv.70001.
Similar to other European countries, a measles epidemic dominated by D8 genotype strains is ongoing since 2022 in our country. Recent reports of liver involvement associated with new measles virus (MeV) strains are scarce. The aim of the study was to compare the clinical characteristics between hospitalized patients with measles from the current epidemic and those from the previous outbreak and to analyze the risk factors associated with hepatic involvement. Data were collected retrospectively for all consecutive adult ( ≥18 years old) patients admitted between October 2022-April 2024 and January 2018-December 2019. A number of 228 patients from the current and 130 from the previous MeV epidemic were included. The main statistically significant differences were those regarding hepatic involvement (77.2% vs. 45.4%, p < 0.001) and significant hepatocellular injury (23.6% vs. 10.7%, p = 0.003). Compared to cases without liver involvement (123), patients with hepatocytolysis (235) had a higher prevalence of keratoconjunctivitis (42.5% vs. 28.4%, p = 0.01), thrombocytopenia (47.6% vs. 34.9%, p = 0.02), severe lymphopenia (51% vs. 35.7%, p = 0.007) and high fibrinogen levels (58.7% vs. 47.1%, p = 0.04). MeV strains from the 2022-2024 epidemic were the strongest predictors of hepatic involvement in the multivariable analysis (odds ratio = 4.3, 95% confidence interval: 2.5-7.4, p < 0.001). The mortality rate of patients with hepatocellular injury was 1.2%. The current measles epidemic is dominated by high rates of hepatic involvement compared to the previous outbreak. Although not associated with a significant mortality, the potential change in MeV hepatotropism could have important clinical implications and warrants further monitoring.
与其他欧洲国家类似，自 2022 年以来，我国一直存在以 D8 基因型为主的麻疹疫情。最近有关新型麻疹病毒（MeV）株引起肝损伤的报道较少。本研究旨在比较当前疫情和以往疫情期间住院麻疹患者的临床特征，并分析与肝损伤相关的危险因素。数据是回顾性收集 2022 年 10 月至 2024 年 4 月和 2018 年 1 月至 2019 年 12 月期间连续收治的所有成年（≥18 岁）患者。本研究纳入了 228 例当前疫情和 130 例以往疫情的 MeV 患者。主要的统计学差异在于肝损伤（77.2%比 45.4%，p<0.001）和明显的肝细胞损伤（23.6%比 10.7%，p=0.003）。与无肝损伤患者（123 例）相比，有肝细胞溶解的患者（235 例）更常见角膜炎（42.5%比 28.4%，p=0.01）、血小板减少症（47.6%比 34.9%，p=0.02）、严重淋巴细胞减少症（51%比 35.7%，p=0.007）和高纤维蛋白原水平（58.7%比 47.1%，p=0.04）。在多变量分析中，2022-2024 年流行的 MeV 株是肝损伤的最强预测因素（比值比=4.3，95%置信区间：2.5-7.4，p<0.001）。肝细胞损伤患者的死亡率为 1.2%。与以往疫情相比，当前麻疹疫情以较高的肝损伤率为主。虽然与显著死亡率无关，但 MeV 嗜肝性的潜在变化可能具有重要的临床意义，需要进一步监测。
