Vassilopoulos D, Younossi Z M, Hadziyannis E, Boparai N, Yen-Lieberman B, Hsi E, Villa-Forte A, Ball E, Kimberly R P, Calabrese L H
Department of Rheumatic and Immunologic Diseases, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
Clin Exp Rheumatol. 2003 Nov-Dec;21(6 Suppl 32):S101-11.
Chronic hepatitis C virus (HCV) infection is associated with an array of autoimmune laboratory and clinical manifestations. The goals of our study were to identify host and/or virological factors that are implicated in the pathogenesis of these manifestations.
We performed a detailed prospective study of various demographic, virological, biochemical, immunological (including lymphocyte subsets, Fc gamma-receptor and HLA class-II genotyping), histological and host genetic parameters in 3 well defined subgroups of HCV patients (n = 40): patients with liver disease only (group I, n = 11) or with laboratory (group II, n = 20) and clinical (group III, n = 9) autoimmune manifestations.
Group III patients, mainly with features of mixed cryoglobulinemia, were older, with higher levels of rheumatoid factor and circulating cryoglobulins while they tended to have a longer estimated disease duration compared to the other two groups of patients. We did not identify any specific immunological features that could differentiate symptomatic versus asymptomatic patients, except from the elevated soluble interleukin-2 receptor levels. An increased frequency of the R/R131 FcR gamma IIIA and the NA1/NA1 Fc gamma RIIIB genotypes was observed in our total HCV population, regardless of autoimmune manifestations, compared to historical controls. No statistically significant differences in HLA class II allele frequencies was detected between patient subgroups or in comparison to healthy controls.
Chronically infected HCV patients with symptomatic mixed cryoglobulinemia display a number of unique characteristics that differentiate them from asymptomatic patients with chronic hepatitis C.
慢性丙型肝炎病毒（HCV）感染与一系列自身免疫性实验室及临床表现相关。我们研究的目的是确定与这些表现发病机制相关的宿主和/或病毒学因素。
我们对3组明确界定的HCV患者（n = 40）进行了详细的前瞻性研究，涉及各种人口统计学、病毒学、生化、免疫学（包括淋巴细胞亚群、Fcγ受体和HLA - II类基因分型）、组织学和宿主遗传参数：仅患有肝病的患者（I组，n = 11）或有实验室（II组，n = 20）及临床（III组，n = 9）自身免疫表现的患者。
III组患者主要有混合性冷球蛋白血症特征，年龄较大，类风湿因子和循环冷球蛋白水平较高，与其他两组患者相比，其估计病程往往更长。除可溶性白细胞介素 - 2受体水平升高外，我们未发现任何可区分有症状与无症状患者的特定免疫学特征。与历史对照相比，在我们的全部HCV患者群体中，无论有无自身免疫表现，均观察到R/R131 FcRγIIIA和NA1/NA1 FcγRIIIB基因型频率增加。在患者亚组之间或与健康对照相比，未检测到HLA - II类等位基因频率有统计学显著差异。
有症状的混合性冷球蛋白血症的慢性HCV感染患者表现出一些独特特征，使其有别于无症状的慢性丙型肝炎患者。
