摘要
据世界卫生组织估计,戊型肝炎病毒(hepatitis E virus,HEV)每年全球约有2 000万例的新发感染,可能导致超过300万例急性肝炎.我国是戊型病毒性肝炎(戊肝)高流行区,近年来戊肝发病人数已超过甲型病毒性肝炎(甲肝).戊肝发病率从2010年的1.77/10万上升至2019年的2.02/10万.我国HEV感染途径主要为食源性感染.慢性HEV感染是指患者感染HEV后,血或粪便中病毒核酸持续阳性3个月以上,其多发生于免疫低下人群,并可能导致患者出现肝纤维化和肝硬化的快速进展.我国以HEV 4型感染为主,因此我国慢性戊肝患者感染的病毒也主要为HEV 4型.HEV感染诊断主要依据特异性HEV抗体或病原学指标.HEV感染筛查应着重关注基础肝病患者、育龄期妇女和老年人及免疫缺陷患者(如器官移植患者、血液肿瘤患者、HIV感染者)等.戊肝诊治中仍然存在很多问题,包括慢性戊肝患者肝纤维化快速进展的危险因素尚未明确;老年男性和孕妇感染HEV后易出现重症的机制有待研究;抗HEV药物筛选多为体外细胞模型的结果,治疗药物仍处于临床前研究阶段.今后应聚焦戊肝的发病机制研究,推动基础研究和临床研究的交叉、融合与转化,为慢性戊肝诊治的药物治疗提供更多有效方案.
Abstract
According to the World Health Organization,hepatitis E virus(HEV)may cause approximately 20 mil-lion new infections annually in the world,and potentially lead to more than 3 million cases of acute hepatitis.Prevalence of viral hepatitis E is high in China,and the number of newly-diagnosed hepatitis E cases has exceeded that of newly-diag-nosed hepatitis A cases.The reported incidence rate of hepatitis E increased from 1.77/100 000 in 2010 to 2.02/100 000 in 2019.HEV infections in China are mainly due to foodborne infections.Chronic HEV infection is defined as the detection of HEV RNA in blood or stools for more than 3 months.It often occurs in immunocompromised populations and may lead to rapid progression of liver fibrosis and cirrhosis in patients.In China,HEV genotype 4 is the predominant genotype,so chronic hepatitis E patients in China are also mainly infected with HEV genotype 4.The diagnosis of HEV infection is mainly based on specific HEV antibodies or pathogenic indicators.HEV infection screening should focus on patients with underlying liver diseases,women of childbearing age and the elderly,as well as immunocompromised patients(such as organ transplant patients,patients with blood tumor,HIV-infected individuals),etc.There are still many problems in the diagnosis and treatment of HEV,including the unclear risk factors for rapid progression of liver fibrosis in patients with chronic hepa-titis E,and the unclear mechanisms on that elderly men and pregnant women are prone to severe cases of HEV infection.The screening of anti-HEV drugs is mostly based on in vitro cell models,which are still in the pre-clinical stage.In the future,research should focus on the pathogenesis of hepatitis E,promoting intersection,integration,and transformation of basic re-search and clinical research,which may provide impetus for the better diagnosis and treatment of chronic hepatitis E.
基金项目
上海市临床重点专科资助项目(shslczdzk01103)
国家自然科学基金面上项目(82270618)
国家科技期刊平台
NSTL
万方数据