Dammacco F, Sansonno D
Department of Biomedical Sciences and Human Oncology, University of Bari Medical School, Italy.
Clin Exp Immunol. 1992 Mar;87(3):352-6. doi: 10.1111/j.1365-2249.1992.tb03001.x.
Although essential mixed cryoglobulinaemia (EMC) is recognized to be frequently associated with chronic liver disease, aetiology and pathogenesis of liver damage remain unsolved questions. The purpose of this study was to assess the possible causative role of hepatitis C virus (HCV) in the liver impairment occurring in patients with EMC. Twenty-six consecutive EMC patients were evaluated. All patients underwent percutaneous liver biopsy. Anti-HCV antibodies were assayed by ELISA and supported by a recombinant immunoblotting assay (4-RIBA). The prevalence of anti-HCV antibodies in patients with and without chronic active liver disease (CALD) was compared. Anti-HCV antibodies were detected in 13 patients (50%) by ELISA and confirmed in 11 of them (42.3%) by 4-RIBA, the remaining two patients being indeterminate in the supportive assay. CALD correlated significantly with anti-HCV antibodies: indeed, 7/11 (63.6%) anti-HCV+ patients showed histological and clinical pictures of CALD, compared with 1/15 (6.6%) anti-HCV- patients (P less than 0.01). With the exception of the patient who was found to be HBsAg+, no liver tissue expressed hepatitis B virus-related antigens in the hepatocytes. Additional histological findings included discrete lymphoid aggregates in portal tracts, siderosis, fatty changes, hyperplasia of Kupffer cells. It can be concluded that chronic liver damage in EMC is frequently associated with anti-HCV antibodies. Although the cause of EMC remains unknown, this study has obvious implications for clarifying the etiology of associated CALD and further supports the therapeutic use of interferons in this disease.
虽然原发性混合性冷球蛋白血症（EMC）被认为常与慢性肝病相关，但肝损伤的病因和发病机制仍是未解之谜。本研究的目的是评估丙型肝炎病毒（HCV）在EMC患者肝脏损害中可能的致病作用。对26例连续的EMC患者进行了评估。所有患者均接受了经皮肝活检。采用酶联免疫吸附测定（ELISA）检测抗HCV抗体，并通过重组免疫印迹法（4-RIBA）进行支持性检测。比较了有和无慢性活动性肝病（CALD）患者中抗HCV抗体的患病率。通过ELISA在13例患者（50%）中检测到抗HCV抗体，其中11例（42.3%）通过4-RIBA得到确认，其余2例患者在支持性检测中结果不确定。CALD与抗HCV抗体显著相关：实际上，7/11（63.6%）抗HCV阳性患者表现出CALD的组织学和临床特征，而抗HCV阴性患者中为1/15（6.6%）（P<0.01）。除1例HBsAg阳性患者外，肝组织中未发现肝细胞表达乙型肝炎病毒相关抗原。其他组织学表现包括门管区离散的淋巴样聚集、铁质沉着、脂肪变性、库普弗细胞增生。可以得出结论，EMC中的慢性肝损伤常与抗HCV抗体相关。虽然EMC的病因仍不清楚，但本研究对于阐明相关CALD的病因具有明显意义，并进一步支持了干扰素在该疾病中的治疗应用。
