Baig Saeeda, Alamgir Mohiuddin
Department of Biochemisty, Ziauddin University Hospital, Karachi.
J Coll Physicians Surg Pak. 2008 Jul;18(7):451-7.
Hepatitis B Virus (HBV) leads to a number of hepatic complications, from acute to chronic hepatitis, cirrhosis and hepatocellular carcinoma, is a well-established fact. Upcoming clinical research, over the years, associates numerous extrahepatic manifestations during the acute and chronic episodes of hepatitis B with significant morbidity and mortality. A causal relationship between HBV and serious autoimmune disorders has also been observed among certain susceptible vaccine recipients in a defined temporal period following immunization. The cause of these extrahepatic manifestations is generally believed to be immune mediated. The most commonly described include skin rash, arthritis, arthralgia, glomerulonephritis, polyarteritis nodosa, and papular acrodermatitis etc. The serum-sickness like "arthritis-dermatitis" prodrome has also been observed in approximately one-third of patients acquiring HBV infections. Skin manifestations of HBV infection typically present as palpable purpura reported to be caused by chronic HBV, although this association remains controversial. To consider the relationship between HBV and other clinically significant disorders as well as serious autoimmune disorders among certain vaccine recipients is the topic of this review. Variable factors that influence extrahepatic manifestation are discussed, including possible synergy between hepatitis B virus and the immune system.
乙肝病毒（HBV）会引发多种肝脏并发症，从急性肝炎到慢性肝炎、肝硬化和肝细胞癌，这是一个公认的事实。多年来，即将开展的临床研究表明，乙肝急性和慢性发作期间的许多肝外表现与显著的发病率和死亡率相关。在特定的免疫接种后的时间段内，某些易感疫苗接种者中也观察到了HBV与严重自身免疫性疾病之间的因果关系。这些肝外表现的原因通常被认为是免疫介导的。最常描述的包括皮疹、关节炎、关节痛、肾小球肾炎、结节性多动脉炎和丘疹性肢端皮炎等。在大约三分之一感染HBV的患者中也观察到了血清病样的“关节炎-皮炎”前驱症状。HBV感染的皮肤表现通常表现为可触及的紫癜，据报道是由慢性HBV引起的，尽管这种关联仍存在争议。考虑HBV与其他具有临床意义的疾病以及某些疫苗接种者中的严重自身免疫性疾病之间的关系是本综述的主题。本文讨论了影响肝外表现的可变因素，包括乙肝病毒与免疫系统之间可能的协同作用。
