Ragab Gaafar, Hussein Mohamed A
Rheumatology and Clinical Immunology Unit, Department of Internal Medicine, Cairo University, Egypt.
J Adv Res. 2017 Mar;8(2):99-111. doi: 10.1016/j.jare.2016.11.002. Epub 2016 Dec 2.
Vasculitis is a remarkable presentation of the extrahepatic manifestations of HCV. According to the presence or absence of cryoglobulins it is subdivided into two main types: cryoglobulinemic vasculitis and non cryoglobulinemic vasculitis based on the attribution of vasculitis to serum cryoglobulins as a pathogenic factor. The attribution of cryoglobulinemia to HCV represents a success story in the history of immunology, microbiology, and clinical medicine. HCV can bind to and invade lymphocytes, consequently triggering an immune response through different mechanisms. The epidemiology of the disease is well described and the clinical picture describes cutaneous, pulmonary, musculoskeletal, neurological, renal, endocrine, gastrointestinal, hepatic and cardiovascular manifestations. It may also be associated with sicca symptoms, an increased risk of lymphoma and serious catastrophic events. The pathology is well characterized. A classification criteria of the syndrome that was validated in 2014 is discussed. Management of CV is decided according to the presence and severity of its clinical presentation. It is divided into asymptomatic, mild, moderate, severe and life threatening disease. Recently introduced direct antiviral agents are proving safe and effective in the management of cryoglobulinemic vasculitis, and it is advocated that the two types of vasculitis be given prioritization in the Egyptian mass campaign to eradicate HCV.
血管炎是丙型肝炎病毒肝外表现的一种显著形式。根据冷球蛋白的有无，它可分为两种主要类型：冷球蛋白血症性血管炎和非冷球蛋白血症性血管炎，这是基于将血管炎归因于血清冷球蛋白作为致病因素。冷球蛋白血症与丙型肝炎病毒的关联是免疫学、微生物学和临床医学史上的一个成功案例。丙型肝炎病毒可结合并侵入淋巴细胞，从而通过不同机制引发免疫反应。该疾病的流行病学已得到充分描述，临床表现包括皮肤、肺部、肌肉骨骼、神经、肾脏、内分泌、胃肠道、肝脏和心血管表现。它还可能与干燥症状、淋巴瘤风险增加和严重灾难性事件有关。其病理学特征明确。讨论了2014年验证的该综合征的分类标准。根据血管炎临床表现的有无和严重程度决定其管理。它分为无症状、轻度、中度、重度和危及生命的疾病。最近引入的直接抗病毒药物在冷球蛋白血症性血管炎的管理中已被证明是安全有效的，并且有人主张在埃及根除丙型肝炎病毒的大规模运动中优先考虑这两种类型的血管炎。
