Hepatitis E and pregnancy: understanding the pathogenesis.
Hepatitis E and pregnancy: understanding the pathogenesis.
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戊型肝炎和妊娠：了解发病机制。
DOI：
10.1111/j.1478-3231.2008.01840.x
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发表时间：
2008-11
影响因子：
6.7
通讯作者：
Shata, Mohamed T.
中科院分区：
文献类型：
--
作者：
Navaneethan, Udayakumar;Al Mohajer, Mayar;Shata, Mohamed T.
戊型肝炎病毒（HEV）是一种单链RNA病毒，可引起急性病毒性肝炎的大规模流行，特别是在发展中国家。在男性和非孕妇中，该病通常是自限性的，病死率低于0.1%。然而，在孕妇中，特别是来自印度某些地理区域的孕妇，HEV感染更严重，通常导致爆发性肝衰竭和相当比例的患者死亡。相比之下，来自埃及、欧洲和美国的报告表明，妊娠期间病毒性肝炎的病程和严重程度与非妊娠妇女没有区别。造成这种地域差异的原因尚不清楚。怀孕期间的高死亡率被认为是继发于怀孕期间相关的激素（雌激素和孕酮）变化以及随之而来的免疫变化。这些免疫学变化包括NF κB的p65组分下调，在T细胞应答中具有主要的Th2偏好沿着由HLA表达介导的宿主易感性因子。到目前为止，研究人员无法解释妊娠期HEV的高发病率，为什么它不同于其他肝炎病毒，如具有相似流行病学特征的甲型肝炎，以及不同地理区域孕妇HEV发病率差异的原因。最近的事态发展，了解免疫反应，戊型肝炎病毒鼓励我们审查可能的机制，这些差异。在不久的将来，需要进一步研究戊型肝炎病毒和妊娠的免疫学，以征服这种疾病。
Hepatitis E virus (HEV) is a single-stranded RNA virus that causes large-scale epidemics of acute viral hepatitis, particularly in developing countries. In men and non pregnant women, the disease is usually self-limited and has a case-fatality rate of less than <0.1%. However in pregnant women particularly from certain geographic areas in India, HEV infection is more severe, often leading to fulminant hepatic failure and death in a significant proportion of patients. In contrast, reports from Egypt, Europe and the USA have shown that the course and severity of viral hepatitis during pregnancy is not different from that in non-pregnant women. The reasons for this geographical difference are not clear. The high mortality rate in pregnancy has been thought to be secondary to the associated hormonal (estrogen and progesterone) changes during pregnancy and consequent immunological changes. These immunological changes include down regulation of p65 component of NF κB with a predominant Th2 bias in the T-cell response along with host susceptibility factors, mediated by HLA expression. Thus far, researchers were unable to explain the high HEV morbidity in pregnancy, why it is different from other hepatitis viruses such as hepatitis A with similar epidemiological features, and the reason behind the difference in HEV morbidity in pregnant women in different geographical regions. The recent developments in understanding the immune response to HEV have encouraged us to review possible mechanisms for these differences. Further research in the immunology of HEV and pregnancy is required to conquer this disease in the near future.
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