戊型肝炎与膈肌功能障碍:病例系列和文献综述。

IF 1.2 Q4 RESPIRATORY SYSTEM
Pneumologie Pub Date : 2024-04-24 DOI:10.1055/a-2291-0560
Michael Westhoff, Andres Arias, Patrick Litterst
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引用次数: 0

摘要

引言 横膈膜瘫痪的原因是多方面的。有报道称神经性肌萎缩(NA)与戊型肝炎病毒(HEV)感染有关。方法从 2020 年 7 月 1 日到 2023 年 8 月 31 日,对出现膈肌功能障碍、同时伴有急性 NA 临床症状或有 NA 病史的患者,以及之前无法解释的膈肌功能障碍患者进行 HEV 感染检查。结果到 2023 年 8 月 31 日,共诊断出 13 名膈肌功能障碍和 HEV 感染患者(4 名女性,9 名男性)。平均年龄为 59 ± 10 岁。所有患者的肝功能值均正常。中位潜伏期为 5 个月(范围:1-48 个月);9 名患者中有 4 名具有典型的 NA 症状,其中 3 名患者表现为双侧膈肌功能障碍。所有患者的 IgG 免疫印迹均呈阳性。7 名患者(其中 3 人患有 NA)的戊型肝炎 IgM 滴度升高,其中 6 人的 IgM 免疫印迹也呈阳性。所有病例均确定为 O2C 型肝炎基因 3 型。结论NA累及膈神经,导致膈肌功能障碍和呼吸困难,可能与 HEV 感染有关。在三年内观察到 13 名横膈膜功能障碍和 HEV 感染患者,这表明人群中未被发现的 HEV 相关横膈膜功能障碍的人数很多,尤其是在没有 NA 症状的情况下。因此,即使在没有NA症状和致病损害事件的膈肌功能障碍患者中,也应考虑HEV感染,因为它可能是仅累及膈神经的NA的一种亚型。在急性期治疗 HEV 相关的横膈膜功能障碍是一个未决问题。鉴于康复预后较差,应讨论抗病毒治疗。不过,目前尚无相关数据。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Hepatitis E and diaphragmatic dysfunction: Case series and review of the literature.
INTRODUCTION The causes of diaphragmatic paresis are manifold. An association between neuralgic amyotrophy (NA) and hepatitis E virus (HEV) infection has been reported. We wondered about the prevalence of diaphragmatic disfunction and hepatitis E infection in our clinic. METHODS From July 1st, 2020 to August 31st, 2023, patients presenting with diaphragmatic dysfunction and simultaneous clinical symptoms of an acute NA, or a history of NA, as well as patients with previously unexplained diaphragmatic dysfunction were examined for HEV infection. RESULTS By August 31st, 2023, 13 patients with diaphragmatic dysfunction and HEV infection were diagnosed (4 women, 9 men). Mean age was 59 ± 10 years. Liver values were normal in all patients. The median latency to diagnosis was five months (range: 1-48 months); nine patients, 4 of them with typical symptoms of NA, presented with acute onset three patients showed bilateral diaphragmatic dysfunction. All patients had a positive IgG immunoblot. Seven patients, three with NA, had an elevated hepatitis E IgM titer and six of them also a positive IgM immunoblot. In all cases, O2C hepatitis genotype 3 was identified. In eight cases, all those with a high IgG titer >125, the O2 genotype 1 was also detected. CONCLUSION NA that shows involvement of the phrenic nerve resulting in diaphragmatic dysfunction and dyspnoea, may be associated with HEV infection. The observation of 13 patients with diaphragmatic dysfunctions and HEV infection within a period of three years indicates a high number of undetected HEV-associated diaphragmatic dysfunction in the population, especially in the absence of NA symptoms. Therefore, even in diaphragmatic dysfunction without NA symptoms and causative damaging event, HEV infection should be considered, as it may represent a subform of NA with only phrenic nerve involvement. Therapy of HEV-associated diaphragmatic dysfunction in the acute phase is an open question. In view of the poor prognosis for recovery, antiviral therapy should be discussed. However, no relevant data are currently available.
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来源期刊
Pneumologie
Pneumologie RESPIRATORY SYSTEM-
CiteScore
1.80
自引率
16.70%
发文量
416
期刊介绍: Organ der Deutschen Gesellschaft für Pneumologie DGP Organ des Deutschen Zentralkomitees zur Bekämpfung der Tuberkulose DZK Organ des Bundesverbandes der Pneumologen BdP Fachärzte für Lungen- und Bronchialheilkunde, Pneumologen und Allergologen
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