甲型肝炎和戊型肝炎是肝脏疾病的相对常见原因。这两种病毒主要通过粪便-口腔途径传播,因此,大多数疫情发生在卫生条件差的国家。作为肝损伤的驱动因素的免疫应答的重要作用也由两种病原体共享。对于甲型肝炎(HAV)和戊型肝炎(HEV)病毒,感染的临床表现主要是急性疾病伴轻度肝损伤,这导致在大多数情况下是自限性的临床和实验室改变。然而,严重的急性或慢性疾病,易受伤害的患者可能会出现持久的表现,比如孕妇,免疫受损的个体或那些预先存在的肝病。具体来说,HAV感染很少导致暴发性肝炎,长期胆汁淤积,由病毒感染引发的复发性肝炎和可能的自身免疫性肝炎。较少见的HEV表现包括肝外疾病,急性肝衰竭和慢性HEV感染伴持续性病毒血症。在本文中,我们对现有文献进行了非系统的审查,以全面了解最新技术。治疗主要包括支持性措施,而病因学治疗和其他严重疾病药物的现有证据在数量和质量上都是有限的。然而,已经尝试了几种治疗方法:对于HAV感染,皮质类固醇治疗显示结果改善,和分子,例如AZD1480,氯化锌和血红素加氧酶-1,已证明在体外病毒复制减少。至于HEV感染,治疗选择主要依靠利巴韦林的使用,一些使用聚乙二醇化干扰素-α的研究显示了相互矛盾的结果。虽然HAV的疫苗已经可用,并已导致该疾病的患病率显着降低,目前正在开发几种HEV疫苗,一些已经在中国可用,显示出有希望的结果。
Hepatitis A and hepatitis E are relatively common causes of liver disease. Both viruses are mainly transmitted through the faecal-oral route and, consequently, most outbreaks occur in countries with poor sanitation. An important role of the immune response as the driver of liver injury is also shared by the two pathogens. For both the hepatitis A (HAV) and hepatitis E (HEV) viruses, the clinical manifestations of infection mainly consist of an acute disease with mild liver injury, which results in clinical and laboratory alterations that are self-limiting in most cases. However, severe acute disease or chronic, long-lasting manifestations may occur in vulnerable patients, such as pregnant women, immunocompromised individuals or those with pre-existing liver disease. Specifically, HAV infection rarely results in fulminant hepatitis, prolonged cholestasis, relapsing hepatitis and possibly autoimmune hepatitis triggered by the viral infection. Less common manifestations of HEV include extrahepatic disease, acute liver failure and chronic HEV infection with persistent viraemia. In this paper, we conduct a non-systematic
review of the available literature to provide a comprehensive understanding of the state of the art. Treatment mainly consists of supportive measures, while the available evidence for aetiological treatment and additional agents in severe disease is limited in quantity and quality. However, several therapeutic approaches have been attempted: for HAV infection, corticosteroid therapy has shown outcome improvement, and molecules, such as AZD 1480, zinc chloride and heme oxygenase-1, have demonstrated a reduction in viral replication in vitro. As for HEV infection, therapeutic options mainly rely on the use of ribavirin, and some studies utilising pegylated interferon-alpha have shown conflicting results. While a vaccine for HAV is already available and has led to a significant reduction in the prevalence of the disease, several vaccines for HEV are currently being developed, with some already available in China, showing promising results.