| Objective:To explore the diagnostic criteria and the most effective treatment measure of chronic hepatitis E through a systematic review of those chronic hepatitis E cases and clinical trials.Methods:Use keywords "hepatitis E" OR "HEV" AND "chronic" NOT "hepatitis B" NOT "hepatitis C", search PUBMED, EMBASE.COM, WEB of Science database, Chinese National Knowledge Infrastructure, Wanfang database, VIP database.Results:This system review involves 29 references, including 25 cases reports, three clinical trials, one article about the mechanism of chronic Hepatitis E, which totally include 125 chronic cases. All of these cases have provided etiologic evidence for diagnosis, and RT-PCR method confirmed that all of the cases are genotype 3.Chronic hepatitis E is mainly characterized by abnormal liver enzymes, and 29 cases with liver biopsy records shows that 19 cases of them have developed into mild or moderate fibrosis shorter than 3 years. The vast majority of patients (116/125 cases) were treated by long-term immunosuppressant after organ transplantation, 8%(10/125 cases) patients showed a Sustained virologic response after reducing immune inhibitors, and no one relapsed. Efficiency rate of Ribavirin antiviral treatment to terminal is as high as 95.6%(86/90 cases), relapse rate was 17.4%(15/86 cases), its main side effects are anemia and leukopenia. The efficiency rate of Interferon antiviral is 87.5%(7/8 cases), the relapse rate was 28.6%(2/7 cases), side effects include acute rejection and bone marrow suppression. Further study about the length of Ribavirin treatment is evaluated by 3 months and 6 months treatment,1st month RVR is 78%(32/41) as well as 21.7%(5/23 cases),3rd month RVR are 100% (41/41) and 69.6%(16/23 cases), and total SVR are 87.8(36/41) and 56.5%(13/23),relapse rate after treatment are 12.2%(5/41) and 31.6%(6/19 cases).Conclusion:1.The diagnosis of chronic hepatitis E must contain abnormal liver enzymes, HEV RNA can be detected positive in serum and (or) stool or liver tissue more than six months, and except for other diseases can cause liver damage.2. Chronic Hepatitis E will accelerate the process of liver fibrosis. Therefore, we suggest that early discontinuation or reduce immunosuppressant drugs to benefit the virology cleared. Ribavirin antiviral treatment is the best therapy for Chronic Hepatitis E, which random from 600-800 mg/d according to hemoglobin level. Three months of treatment is suggested for those who had completely clear virus in the first month, otherwise a course of more than 6 months should be performed.3.Subsequent large epidemiological survey and clinical study are necessary for further clarify of chronic hepatitis E, and a stable cell system of HEV is the basic of mechanism study of hepatitis E. |
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