一项日本丙型肝炎病毒感染与口腔扁平苔藓的回顾性病例对照研究：与丙型肝炎病毒核心和 NS5A 区突变的关联研究。
A retrospective case-control study of hepatitis C virus infection and oral lichen planus in Japan: association study with mutations in the core and NS5A region of hepatitis C virus.
机构信息
Department of Digestive Disease Information & Research, Kurume University School of Medicine, Kurume, Fukuoka, Japan.
出版信息
BMC Gastroenterol. 2012 Apr 10;12:31. doi: 10.1186/1471-230X-12-31.
BACKGROUND
The aims of this study were to assess the prevalence of hepatitis C virus (HCV) infection in Japanese patients with oral lichen planus and identify the impact of amino acid (aa) substitutions in the HCV core region and IFN-sensitivity-determining region (ISDR) of nonstructural protein 5A (NS5A) associated with lichen planus.
METHODS
In this retrospective study, 59 patients (group 1-A) with oral lichen planus among 226 consecutive patients who visited our hospital and 85 individuals (group 1-B, controls) with normal oral mucosa were investigated for the presence of liver disease and HCV infection. Risk factors for the presence of oral lichen planus were assessed by logistic regression analysis. We compared aa substitutions in the HCV core region (70 and/or 91) and ISDR of NS5A of 12 patients with oral lichen planus (group 2-A) and 7 patients who did not have oral lichen planus (group 2-B) among patients (high viral loads, genotype 1b) who received interferon (IFN) therapy in group1-A.
RESULTS
The prevalence of anti-HCV and HCV RNA was 67.80% (40/59) and 59.32% (35/59), respectively, in group 1-A and 31.76% (27/85) and 16.47% (14/85), respectively, in group 1-B. The prevalence of anti-HCV (P < 0.0001) and HCV RNA (P < 0.0001) in group 1-A was significantly higher than those in group 1-B. According to multivariate analysis, three factors - positivity for HCV RNA, low albumin level (< 4.0 g/dL), and history of smoking - were associated with the development of oral lichen planus. The adjusted odds ratios for these three factors were 6.58, 3.53 and 2.58, respectively, and each was statistically significant. No significant differences in viral factors, such as aa substitutions in the core region and ISDR of NS5A, were detected between the two groups (groups 2-A and -B).
CONCLUSION
We observed a high prevalence of HCV infection in patients with oral lichen planus. Longstanding HCV infection, hypoalbuminemia, and smoking were significant risk factors for the presence of oral lichen planus in patients. It is advisable for Japanese patients with lichen planus to be tested for HCV infection during medical examination.
背景
本研究旨在评估丙型肝炎病毒（HCV）在日本口腔扁平苔藓患者中的感染率，并确定 HCV 核心区和非结构蛋白 5A 的 IFN 敏感性决定区（ISDR）中与扁平苔藓相关的氨基酸（aa）取代对其的影响。
方法
在这项回顾性研究中，我们调查了 226 例连续就诊患者中的 59 例（1-A 组）口腔扁平苔藓患者和 85 例（1-B 组，对照组）口腔黏膜正常者中是否存在肝病和 HCV 感染。采用 logistic 回归分析评估口腔扁平苔藓存在的危险因素。我们比较了 1-A 组中接受干扰素（IFN）治疗的 12 例口腔扁平苔藓患者（2-A 组）和 7 例无口腔扁平苔藓患者（2-B 组）中 HCV 核心区（70 和/或 91）和 NS5A 的 ISDR 的 aa 取代。
结果
1-A 组抗-HCV 和 HCV RNA 的阳性率分别为 67.80%（40/59）和 59.32%（35/59），1-B 组分别为 31.76%（27/85）和 16.47%（14/85）。1-A 组抗-HCV（P<0.0001）和 HCV RNA（P<0.0001）的阳性率显著高于 1-B 组。多因素分析显示，HCV RNA 阳性（P<0.0001）、低白蛋白水平（<4.0 g/dL）和吸烟史（P<0.0001）与口腔扁平苔藓的发生有关。这三个因素的调整比值比分别为 6.58、3.53 和 2.58，均具有统计学意义。两组（2-A 组和 2-B 组）之间的病毒因素，如核心区的 aa 取代和 NS5A 的 ISDR，无显著差异。
结论
我们观察到口腔扁平苔藓患者中 HCV 感染的高患病率。长期 HCV 感染、低白蛋白血症和吸烟是口腔扁平苔藓患者存在的显著危险因素。日本的扁平苔藓患者在体检时应检测 HCV 感染。
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