Clinical Experimental Onco-Hematology Unit, Centro di Riferimento Oncologico (CRO) IRCCS, 33081 Aviano, Italy.
Cancer Epidemiology Unit, Centro di Riferimento Oncologico (CRO) IRCCS, 33081 Aviano, Italy.
Viruses. 2021 May 30;13(6):1032. doi: 10.3390/v13061032.
Hepatitis B virus (HBV) chronic infection causes progressive liver damage, although about 20% of patients develop extrahepatic manifestations such as cryoglobulinemic vasculitis (CV). Clinical manifestations range from mild to moderate (purpura, asthenia, arthralgia) to severe (leg ulcers, peripheral neuropathy, glomerulonephritis, non-Hodgkin lymphoma). A comprehensive review of therapeutic options for HBV-related CV is lacking. Nucleos(t)ide analogues (NA) suppress HBV replication in 90-100% of cases and induce clinical response in most patients with mild-to-moderate CV. Plasma exchange can be performed in patients with severe CV and should be considered in severe or life-threatening cases combined with high doses of corticosteroids and antiviral treatment. A cautious use of rituximab can be considered only in association with NA treatment in refractory cases. A review of the literature and an analysis of data collected by six centers of the Italian Group for the Study of Cryoglobulinemia on 18 HBV-CV nucleotide/nucleoside analogues (NAs)-treated patients were carried out.
乙型肝炎病毒（HBV）慢性感染可导致进行性肝损伤，尽管约 20%的患者出现肝外表现，如冷球蛋白血症性血管炎（CV）。临床表现从轻度到中度（紫癜、乏力、关节炎）到重度（腿部溃疡、周围神经病、肾小球肾炎、非霍奇金淋巴瘤）不等。缺乏针对 HBV 相关 CV 的治疗选择的综合综述。核苷酸（酸）类似物（NA）可抑制 90-100%的病例中的 HBV 复制，并诱导大多数轻度至中度 CV 患者的临床反应。在严重 CV 患者中可以进行血浆置换，并且在严重或危及生命的情况下应与大剂量皮质类固醇和抗病毒治疗结合考虑。在难治性病例中，仅在与 NA 治疗联合使用时才可谨慎使用利妥昔单抗。对意大利冷球蛋白血症研究组六个中心收集的 18 例 HBV-CV 核苷酸/核苷类似物（NA）治疗患者的文献进行了回顾和数据分析。
