丙型肝炎病毒感染患者伴和不伴可检测到混合冷球蛋白血症的系统性血管炎。

Systemic vasculitis in patients with hepatitis C virus infection with and without detectable mixed cryoglobulinemia.

机构信息

Department of Internal Medicine, APHP Groupe Hospitalier Pitié-Salpétrière, 47 boulevard de l'Hôpital, 75013 Paris, France.

出版信息

J Rheumatol. 2011 Jan;38(1):104-10. doi: 10.3899/jrheum.100191. Epub 2010 Oct 15.

DOI:10.3899/jrheum.100191

PMID:20952479

Abstract

OBJECTIVE

to describe hepatitis C virus (HCV)-related systemic vasculitis in patients without detectable mixed cryoglobulinemia (MC) and to compare them to typical cases of HCV-MC vasculitis.

METHODS

twelve HCV RNA+ patients with histologically proven vasculitis in the absence of detectable MC (cases) were retrospectively compared with 48 HCV RNA+ patients with MC vasculitis (controls). Each case was matched with 4 controls for age and sex.

RESULTS

the main epidemiological and virologic features were similar between cases and controls. No clinical difference was found, except for lower rates of arthralgias (33% vs 71%; p = 0.02) and purpura (50% vs 83%; p = 0.03) in cases. Cases showed higher mean serum C3 (1.17 ± 0.21 vs 0.93 ± 0.23 g/l; p = 0.01) and median C4 levels (0.25 vs 0.04 g/l; p < 0.001), lower median serum IgM levels (0.6 vs 1.9 g/l; p < 0.001), and lower rates of rheumatoid factor positivity (8% vs 82%; p < 0.001) than controls. The main histologic features were similar between cases and controls. Immunofluorescence analysis of skin biopsy from 1 case revealed perivascular deposits of C3 and IgA. After treatment, overall clinical response of vasculitis (75% vs 83%) and sustained virological response (40% vs 64%; p = 0.3) were similar between cases and controls, except for higher complete clinical response (42% vs 73%; p = 0.05) in controls.

CONCLUSION

HCV-related systemic vasculitis may occur in the absence of detectable MC. Our findings suggest that such vasculitis probably results from immune complex-mediated mechanisms, and that the therapeutic management of such vasculitis should be similar to that of HCV-MC vasculitis.

摘要

目的

描述无混合性冷球蛋白血症（MC）可检测的丙型肝炎病毒（HCV）相关系统性血管炎，并将其与典型的 HCV-MC 血管炎病例进行比较。

方法

回顾性分析 12 例组织学证实的无 MC 可检测的 HCV RNA+患者（病例组），并与 48 例 HCV RNA+MC 血管炎患者（对照组）进行比较。每个病例均与 4 例年龄和性别相匹配的对照进行匹配。

结果

病例组和对照组的主要流行病学和病毒学特征相似。除了病例组关节痛（33% vs 71%；p = 0.02）和紫癜（50% vs 83%；p = 0.03）发生率较低外，两组之间无临床差异。病例组的平均血清 C3 水平（1.17 ± 0.21 vs 0.93 ± 0.23 g/L；p = 0.01）和中位 C4 水平（0.25 vs 0.04 g/L；p < 0.001）较高，中位血清 IgM 水平（0.6 vs 1.9 g/L；p < 0.001）较低，类风湿因子阳性率（8% vs 82%；p < 0.001）较低。病例组和对照组的主要组织学特征相似。1 例皮肤活检的免疫荧光分析显示血管周围有 C3 和 IgA 沉积。经过治疗，血管炎的整体临床缓解率（75% vs 83%）和持续病毒学应答率（40% vs 64%；p = 0.3）在病例组和对照组之间相似，但对照组的完全临床缓解率（42% vs 73%；p = 0.05）较高。