Gower R G, Sausker W F, Kohler P F, Thorne G E, McIntosh R M
J Allergy Clin Immunol. 1978 Oct;62(4):222-8. doi: 10.1016/0091-6749(78)90211-7.
In a comprehensive study of 80 patients with vasculitis, 4 had concurrent hepatitis B virus (HBV) infection. Polyarteritis nodosa was present in 2 and in the other 2, cutaneous vasculitis, presenting clinically as palpable or Henoch-Schönlein purpura. In one of these patients skin biopsies demonstrated granular deposits of IgM, C3, C4, and the hepatitis B surface antigen (HBsAg) and electron-dense deposits of aggregated 20-nm particles resembling HBsAg in postcapillary venules. Evidence for circulating HBsAg-immune complexes included increased serum Clq binding activity, decreased serum complement, and a cryoprecipitate containing both HBsAg and IgM anti-HBs. Aggregated 20-nm particles resembling intact HBsAg were also seen by negative staining electron microscopy of the serum cryoprecipitate. This patient fulfills all the criteria for a specific immune complex vasculitis caused by his immune response to a chronic HBV infection. These findings emphasize that HBV infection may be associated with small vessel vasculitis as well as polyarteritis nodosa, mixed cryoglobulinemia, and glomerulonephritis. A similar immune response to other viral infections may be expressed as palpable (Henoch-Schönlein) purpura also.
在一项对80例血管炎患者的综合研究中，有4例同时感染了乙型肝炎病毒（HBV）。其中2例患有结节性多动脉炎，另外2例为皮肤血管炎，临床表现为可触及的紫癜或过敏性紫癜。在其中1例患者中，皮肤活检显示在毛细血管后微静脉中有IgM、C3、C4和乙型肝炎表面抗原（HBsAg）的颗粒状沉积，以及类似于HBsAg的20纳米聚集颗粒的电子致密沉积。循环中HBsAg免疫复合物的证据包括血清Clq结合活性增加、血清补体降低以及一种同时含有HBsAg和IgM抗HBs的冷沉淀物。通过血清冷沉淀物的负染色电子显微镜检查也可见到类似于完整HBsAg的聚集20纳米颗粒。该患者符合因对慢性HBV感染的免疫反应而导致的特异性免疫复合物血管炎的所有标准。这些发现强调，HBV感染可能与小血管血管炎以及结节性多动脉炎、混合性冷球蛋白血症和肾小球肾炎有关。对其他病毒感染的类似免疫反应也可能表现为可触及的（过敏性）紫癜。
