Giannitti C, Morozzi G, D'Alfonso S, Bellisai F, Galeazzi M
Sezione di Reumatologia, Dipartimento Medicina Clinica e Scienze Immunologiche, Università di Siena, Siena.
Reumatismo. 2008 Jul-Sep;60(3):192-8. doi: 10.4081/reumatismo.2008.192.
To test whether an association between HCV genotype, HLA class II alleles distribution and extra-hepatic manifestations (EHM ) can be demonstrated in a group of Italian patients with chronic HCV infection .
Sixty patients affected by HCV infection with EHM were consecutively enrolled. 163 HCV patients without EHM were tested as controls for the prevalence of HCV genotypes, while we referred to literature as to the controls for HLA distribution. HCV-RNA was quantified by a RT-PCR. HLA class II alleles typing was performed using a standard microlymphocytotoxicity assay. We used chi-square or Fisher test (p<0.05 significant). Odds Ratio (OR) was performed by 2X2 contingency table.
HCV 2c genotype was found in 63.46% of patients compared to 19.63% of controls (p<0.0001; OR=7.11). Furthermore, it correlated with carpal tunnel syndrome (p=0.03; OR=4.5) and autoimmune thyroiditis (p=0.02; OR=9.2). On the contrary, 1b genotype protected from EHM in toto (p=0.0004; OR=0.21) and particularly from carpal tunnel syndrome (p=0.0014; OR=0.07). Moreover, 3a genotype prevented HCV people from having cryoglobulinemia (p=0.05; OR=0.11). As to HLA, DR6 seemed to facilitate EHM in HCV patients (p=0.041; OR=1.61), while DQ2 (p=0.03; OR=0.5) and DQ3 (p=0.002; OR= 0.5) may play a protective role. In addition, HLA DR3 was associated with cryoglobulinemia (p=0.02; OR=9.5).
According to our findings, 2c genotype can be considered as a major risk factor for developing HCVrelated EHM, while 1b genotype seems to prevent their onset; there are also evidences suggesting that HLA might play a role in chronic HCV infected patients.
检测在一组患有慢性丙型肝炎病毒（HCV）感染的意大利患者中，是否能证明HCV基因型、人类白细胞抗原（HLA）II类等位基因分布与肝外表现（EHM）之间存在关联。
连续纳入60例患有HCV感染且有肝外表现的患者。163例无肝外表现的HCV患者作为HCV基因型流行情况的对照，而HLA分布的对照则参考相关文献。通过逆转录聚合酶链反应（RT-PCR）对HCV-RNA进行定量。使用标准微量淋巴细胞毒性试验进行HLA II类等位基因分型。我们采用卡方检验或费舍尔检验（p<0.05具有显著性）。优势比（OR）通过2×2列联表计算得出。
63.46%的患者检测出HCV 2c基因型，而对照组为19.63%（p<0.0001；OR=7.11）。此外，它与腕管综合征（p=0.03；OR=4.5）和自身免疫性甲状腺炎（p=0.02；OR=9.2）相关。相反，1b基因型总体上可预防肝外表现（p=0.0004；OR=0.21），尤其可预防腕管综合征（p=0.0014；OR=0.07）。此外，3a基因型可使HCV患者避免发生冷球蛋白血症（p=0.05；OR=0.11）。关于HLA，DR6似乎会促进HCV患者出现肝外表现（p=0.041；OR=1.61），而DQ2（p=0.03；OR=0.5）和DQ3（p=0.002；OR=0.5）可能起到保护作用。此外，HLA DR3与冷球蛋白血症相关（p=0.02；OR=9.5）。
根据我们的研究结果，2c基因型可被视为发生HCV相关肝外表现的主要危险因素，而1b基因型似乎可预防其发生；也有证据表明HLA可能在慢性HCV感染患者中发挥作用。
