Chouela E, Abeldaño A, Panetta J, Ducard M, Neglia V, Sookoian S, Kina M, Castaño G, Vereytou F, Frider B
Dermatology Unit, Cosme Argerich County Hospital, University of Buenos Aires, Argentina.
Int J Dermatol. 1996 Nov;35(11):797-9. doi: 10.1111/j.1365-4362.1996.tb02977.x.
In cases of psoriasis (PS), the etiology of the underlying liver disease is occasionally unknown. To investigate antibodies to hepatitis C virus (anti-HCV), their prevalence and clinical significance, 118 unselected outpatients with PS were studied prospectively.
Anti-HCV was assayed in serum by second-generation enzyme-linked immunosorbent assay (ELISA), considering a serum anti-HCV (+), when the optical density ratio was equal to or greater than three times the cut-off value, in duplicate determinations, whereas anti-HBc, anti-HBs, HBsAg, anti-HBe, and HBeAg were also evaluated by ELISA, as were the transaminases. As controls we took the 1.2% anti-HCV prevalence found in 60,000 blood donors from Buenos Aires city.
Nine of 118 serum samples (7.6%) proved to be anti-HCV (+) (P < 0.001). There were no differences between positive and negative cases as regards gender, age, history of hepatitis, transfusions, or parenteral exposure, disease duration, or psoriasis type, and prior treatment with methotrexate and etretinate. Fifteen percent (17/113) were anti-HBc (+), 64.7% anti-HBs (+) (11/17) and 2.5% HBsAg (+) (3/17), whereas 3/17 (2.5%) showed isolated anti-HBc positivity. Liver biopsies in six anti-HCV patients disclosed four with chronic active hepatitis, one with cirrhosis, and one with steatosis.
In the presence of liver disease in PS patients, an HCV infection should be considered as an alternative diagnosis. The high anti-HCV prevalence in this series is attributable to infection by inapparent parenteral routes, through minute skin abrasions, as reported for hepatitis B virus in PS.
在银屑病（PS）病例中，潜在肝脏疾病的病因有时不明。为了研究丙型肝炎病毒抗体（抗-HCV）、其患病率及临床意义，我们对118例未经挑选的PS门诊患者进行了前瞻性研究。
采用第二代酶联免疫吸附试验（ELISA）检测血清中的抗-HCV，当光密度比值等于或大于临界值的三倍时，重复测定两次，将血清抗-HCV（+）视为阳性，同时通过ELISA检测抗-HBc、抗-HBs、HBsAg、抗-HBe和HBeAg，以及转氨酶。我们以从布宜诺斯艾利斯市60000名献血者中发现的1.2%的抗-HCV患病率作为对照。
118份血清样本中有9份（7.6%）抗-HCV（+）（P < 0.001）。在性别、年龄、肝炎病史、输血史或非肠道暴露史、病程、银屑病类型，以及既往使用甲氨蝶呤和维甲酸治疗方面，阳性和阴性病例之间没有差异。15%（17/113）抗-HBc（+），64.7%抗-HBs（+）（11/17），2.5% HBsAg（+）（3/17），而3/17（2.5%）表现为单纯抗-HBc阳性。6例抗-HCV患者的肝活检显示，4例为慢性活动性肝炎，1例为肝硬化，1例为脂肪变性。
在PS患者存在肝脏疾病的情况下，应考虑丙型肝炎病毒感染作为一种鉴别诊断。本系列中较高的抗-HCV患病率归因于如银屑病中乙型肝炎病毒报道的那样，通过微小皮肤擦伤经不明显的非肠道途径感染。
