Sasaki-Tanaka Reina, Kanda Tatsuo, Yokoo Takeshi, Abe Hiroyuki, Hayashi Kazunao, Sakamaki Akira, Kamimura Hiroteru, Terai Shuji
Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8520, Japan.
Division of Gastroenterology and Hepatology, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Uonuma Kikan Hospital, Minami-Uonuma, Niigata 949-7302, Japan.
Pathogens. 2025 May 6;14(5):454. doi: 10.3390/pathogens14050454.
Acute-on-chronic liver failure (ACLF) and acute liver failure (ALF) are severe hepatitis that occur in patients with and without chronic liver diseases and/or cirrhosis, respectively, and both often result in death. Hepatitis A virus (HAV) and hepatitis E virus (HEV) infection can cause these severe conditions. We reviewed the role of HAV and HEV, which infect humans through the fecal-oral route, in ALF and ACLF in Asian countries. This narrative review was the derived from a traditional non-systematic review. Hepatitis A should be recognized as one of the sexually transmitted infections, especially among men who have sex with men. HAV genotype IIIA infection seems to present a more severe clinical manifestation. Acute HEV-1 infection is associated with ALF in pregnant women in India. HEV-4, rather than HEV-3, was found in severe hepatitis in Japan. HEV also plays a role as a cause of acute insult and/or chronic liver disease in immunocompromised patients with ACLF. Further studies are needed for the development of vaccines and antivirals against HAV and HEV infections. Despite the limitations of the recording of cases and the extent of specific vaccinations, multidisciplinary cooperation, involving hepatologists, virologists, experts in public health, etc., may improve the treatment of HAV and HEV infection.
慢加急性肝衰竭（ACLF）和急性肝衰竭（ALF）分别是发生于患有和未患有慢性肝病和/或肝硬化患者的严重肝炎，二者常导致死亡。甲型肝炎病毒（HAV）和戊型肝炎病毒（HEV）感染可引发这些严重病症。我们回顾了经粪-口途径感染人类的HAV和HEV在亚洲国家ALF和ACLF中的作用。本叙述性综述源自传统的非系统性综述。甲型肝炎应被视为性传播感染之一，尤其是在男男性行为者中。HAV基因III A型感染似乎呈现出更严重的临床表现。急性HEV-1感染与印度孕妇的ALF有关。在日本的严重肝炎中发现的是HEV-4而非HEV-3。HEV在患有ACLF的免疫功能低下患者中也是急性损伤和/或慢性肝病的病因之一。针对HAV和HEV感染的疫苗及抗病毒药物研发还需要进一步研究。尽管病例记录和特定疫苗接种范围存在局限性，但肝病学家、病毒学家、公共卫生专家等多学科合作可能会改善HAV和HEV感染的治疗。
