Sterling Richard K, Bralow S
Division of Gastroenterology, Hepatology, and Nutrition, Virginia Commonwealth University Health System, 1200 E. Broad Street, West Hospital, Room 1492, Richmond, VA 23298, USA.
Curr Gastroenterol Rep. 2006 Feb;8(1):53-9. doi: 10.1007/s11894-006-0064-y.
Given the high prevalence of chronic hepatitis C virus (HCV) infection, its clinical sequelae account for a significant proportion of patients presenting to gastroenterologists and hepatologists. Whereas the hepatic manifestations of hepatitis C are well described, including hepatitis, cirrhosis, and the development of hepatocellular carcinoma, the extrahepatic manifestations, though common, are less well appreciated. Although nonspecific, fatigue and arthralgias are very common in those with chronic hepatitis C. Extrahepatic syndromes have been reported in as much as 36% of HCV patients, but the exact prevalence is not known. Patients with these syndromes can be divided into those with a high degree of association and those with a more moderate or mild association with HCV. The most prevalent extrahepatic diseases with the highest degree of association with HCV are the essential mixed cryoglobulins with skin, neurologic, renal, and rheumatologic complications. Non-cryoglobulin diseases with a less definite relationship to HCV include systemic vasculitis, splenic lymphoma, porphyria cutanea tarda, and the sicca syndromes. This article highlights the pathophysiology and clinical manifestations of these disorders.
鉴于慢性丙型肝炎病毒（HCV）感染的高流行率，其临床后遗症在就诊于胃肠病学家和肝病学家的患者中占相当大的比例。虽然丙型肝炎的肝脏表现已有充分描述，包括肝炎、肝硬化和肝细胞癌的发生，但肝外表现虽然常见，却较少受到重视。虽然非特异性，但疲劳和关节痛在慢性丙型肝炎患者中非常常见。据报道，高达36%的HCV患者出现肝外综合征，但确切患病率尚不清楚。患有这些综合征的患者可分为与HCV高度相关和中度或轻度相关的两类。与HCV关联度最高的最常见肝外疾病是伴有皮肤、神经、肾脏和风湿并发症的原发性混合性冷球蛋白血症。与HCV关系不太明确的非冷球蛋白血症疾病包括系统性血管炎、脾淋巴瘤、迟发性皮肤卟啉病和干燥综合征。本文重点介绍了这些疾病的病理生理学和临床表现。
