Sharma Aman, Sharma Kusum
Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India.
Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India.
J Clin Exp Hepatol. 2013 Sep;3(3):204-12. doi: 10.1016/j.jceh.2013.06.001. Epub 2013 Jul 8.
Two hepatotropic viruses have been shown to have causal relationship with systemic vasculitis-hepatitis B with classical polyarteritis nodosa and hepatitis C with cryoglobulinemic vasculitis. The present paper provides an updated overview on the clinical presentations and management of these vasculitides. HBV associated PAN patients have higher weight loss, peripheral neuropathy, mononeuritis multiplex, abdominal pain, gastrointestinal manifestations requiring surgery, cardiomyopathy, orchitis, hypertension, and/or elevated transaminase levels. Microaneurysms are also more common in mesenteric artery. Skin manifestations, however are less common. These patients also have a severe disease as suggested by higher five factor score and higher BVAS. Though relapses are less common, mortality is higher in patients with HBV PAN as compared to non HBV PAN. Plasmapheresis has a role in treatment in clearing off immune complexes. The common clinical manifestations of HCV associated cryoglobulinemic vasculitis are skin lesions, peripheral neuropathy, glomerulonephritis, arthritis, and sicca symptoms. Though combination therapy comprising of pegylated interferon α and ribavirin is the first line of management, immunotherapy is needed for severe or life threatening manifestations. Recent randomized trials have shown the efficacy of rituximab in such situations.
两种嗜肝病毒已被证明与系统性血管炎存在因果关系，即乙型肝炎与经典结节性多动脉炎相关，丙型肝炎与冷球蛋白血症性血管炎相关。本文提供了这些血管炎临床表现及治疗的最新概述。与乙肝相关的结节性多动脉炎患者体重减轻、周围神经病变、多发性单神经炎、腹痛、需要手术治疗的胃肠道表现、心肌病、睾丸炎、高血压及转氨酶水平升高更为常见。微动脉瘤在肠系膜动脉中也更常见。然而，皮肤表现则较少见。这些患者的疾病也较为严重，五因素评分和BVAS评分较高即表明了这一点。虽然复发较少见，但与非乙肝相关的结节性多动脉炎患者相比，乙肝相关的结节性多动脉炎患者死亡率更高。血浆置换在清除免疫复合物的治疗中发挥作用。丙型肝炎相关冷球蛋白血症性血管炎的常见临床表现为皮肤病变、周围神经病变、肾小球肾炎、关节炎及干燥症状。虽然聚乙二醇化干扰素α和利巴韦林联合治疗是一线治疗方法，但对于严重或危及生命的表现则需要免疫治疗。近期的随机试验已表明利妥昔单抗在这种情况下的疗效。
