Mason A
Division of Gastroenterology, University of Alberta, Zeidler Ledcor Centre, 130 University Campus, Edmonton, Alberta, Canada.
Minerva Gastroenterol Dietol. 2006 Mar;52(1):53-66.
Approximately 20% of patients with hepatitis B virus (HBV) infection may experience extrahepatic disease. These manifestations include a viral prodrome with a serum sickness-like syndrome, polyarteritis nodosa, glomerulonephritis, as well as various neurological and dermatologic diseases amongst other manifestations. The viral pathogenesis is not well understood and has been difficult to study due to the lack of an animal model of HBV-related extrahepatic disease. Deposition of immune complexes and activation of the complement cascade has been most widely studied. However, circulating immune complexes are physiologic and occur more frequently than extrahepatic disease. Also, HBV-related extrahepatic syndromes occur in the absence of immune complex formation. Several studies support the notion that HBV replication in extrahepatic tissues may also precipitate disease but extrahepatic replication has commonly been observed without any apparent cytopathic or immune related tissue damage. It is clear that suppression of viral replication with antiviral therapy or spontaneous viral clearance positively correlates with resolution of extrahepatic disease. The use of continuous immunosuppressive therapy has largely been abandoned with the advent of robust antiviral strategies to manage disease. These data support the notion that a combination of factors including inadequate clearance immune complexes and viral replication in extrahepatic tissues play an important role in the pathogenesis. This conceptual framework is potentially significant as it emphasizes the importance of antiviral treatment in the management of extrahepatic disease.
约20%的乙型肝炎病毒（HBV）感染者可能会出现肝外疾病。这些表现包括伴有血清病样综合征的病毒前驱症状、结节性多动脉炎、肾小球肾炎，以及各种神经和皮肤疾病等其他表现。病毒发病机制尚未完全明确，由于缺乏HBV相关肝外疾病的动物模型，一直难以进行研究。免疫复合物的沉积和补体级联反应的激活是研究最为广泛的方面。然而，循环免疫复合物是生理性的，其出现频率高于肝外疾病。此外，HBV相关肝外综合征在无免疫复合物形成的情况下也会发生。多项研究支持肝外组织中HBV复制也可能引发疾病这一观点，但通常观察到肝外复制时并无明显的细胞病变或免疫相关组织损伤。显然，抗病毒治疗抑制病毒复制或病毒自然清除与肝外疾病的缓解呈正相关。随着强效抗病毒策略用于疾病管理的出现，持续免疫抑制治疗的应用已基本被摒弃。这些数据支持了这样一种观点，即包括免疫复合物清除不足和肝外组织中病毒复制在内的多种因素在发病机制中起重要作用。这一概念框架可能具有重要意义，因为它强调了抗病毒治疗在肝外疾病管理中的重要性。
