丙型肝炎感染的肝外表现

A. Frosi
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摘要

慢性丙型肝炎病毒(HCV)感染是世界范围内肝脏疾病的主要原因,也是肝外表现(EHM)的原因,涉及许多不同的器官和器官:皮肤、唾液腺、眼睛、甲状腺、肾脏、外周和中枢神经系统以及免疫系统。混合性冷球蛋白血症是最常见、最著名且与丙型肝炎病毒密切相关的EHM。HCV和b细胞非霍奇金淋巴瘤之间存在显著关联,尽管HCV感染患者的淋巴瘤发病率总体上仍然很低。感染丙型肝炎病毒的患者胰岛素抵抗、糖尿病和动脉粥样硬化的发病率增加,这可能导致心血管疾病的增加。引起丙型肝炎病毒感染肝外效应的机制可能是多因素的,可能包括内分泌效应、丙型肝炎病毒在肝外细胞中的复制或具有全身效应的免疫反应增强。由于这种关联,建议对临床状况与丙型肝炎相关的患者进行丙型肝炎感染检测。相反,诊断为丙型肝炎感染的患者应进行可能的EHM评估。HCV的EHM可以被认为是直接作用抗病毒药物抗病毒治疗的确定适应症,即使没有明显的肝脏疾病。成功根除丙型肝炎病毒可以改善并在某些情况下治愈丙型肝炎病毒的EHM。B细胞消耗剂可能被认为是更严重EHM患者联合抗病毒药物的最佳生物学靶点选择。
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Extrahepatic Manifestations of Hepatitis C Infection
Chronic infection with the hepatitis C virus (HCV) is a major cause of liver disease worldwide and is also responsible for extrahepatic manifestations (EHM) involving many different organs and apparatus: skin, salivary glands, eyes, thyroid, kidneys, peripheral and central nervous system, and immune system. Mixed cryoglobulinemia is the most frequent, best known and strictly HCV-associated EHM. A significant association between HCV and B-cell Non-Hodgkin-Lymphoma is reported although the incidence of lymphoma among HCV-infected patients overall remains low. HCV-infected patients have increased rates of insulin resistance, diabetes, and atherosclerosis, which may lead to increased cardiovascular disorders. The mechanisms causing the extrahepatic effects of HCV infection are likely multifactorial and may include endocrine effects, HCV replication in extrahepatic cells, or a heightened immune reaction with systemic effects. Because of this associations, it is suggested testing for HCV infection the patients with a clinical condition described as linked to hepatitis C. Conversely, patients diagnosed with HCV infection should have evaluation for a possible EHM. EHM of HCV can be considered an established indication for antiviral treatment with direct acting antivirals, even in the absence of overt liver disease. Successful eradication of HCV can improve and in some cases cure EHM of HCV. B cell depleting agents may be considered to be the best biological target option for patients with more severe EHM in combination with the antivirals.
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