Tomoe M, Takatori M, Iwabuchi S, Iino S
Second Department of Internal Medicine, St. Marianna University School of Medicine.
Nihon Shokakibyo Gakkai Zasshi. 1997 Apr;94(4):241-8.
The association between the actual status of cryoglobulins (CGs) expression in hepatitis C-related chronic liver disease (C-CLD) and different types of liver pathology, HCV-RNA titers and genotypes was investigated. Sixteen out of 1340 ordinary clinical specimens were CGs-positive (1%), and in 8 of them (50%) the patients blood was HCV-RNA positive. CGs was detected in 63% of C-CLD patients as a whole, but when compared with the histological findings in the liver, it was 88% in F3, and 92% in A3, and thus high percentages were detected in patients with progression of liver fibrosis and patients with strong activity. Serum IgG, IgM, transaminase and gamma-GTP levels were significantly higher in the patients with CGs, and their RA test and C3dCIC levels tended to be higher, but the differences were not significant, and no association was found with the anti-nuclear antibody positive level, or the HCV-RNA titers or genotypes. Based on the above, there was a clear involvement of HCV infection, especially the activity and histological progression of hepatitis in CGs formation in Japan as well, but there were few extrahepatic manifestations, suggesting differences in CGS levels and immune response to CGs from cases in Western countries.
研究了丙型肝炎相关慢性肝病(C-CLD)中冷球蛋白(CGs)表达的实际状况与不同类型肝脏病理、HCV-RNA滴度及基因型之间的关联。在1340份普通临床标本中,16份CGs呈阳性(1%),其中8份(50%)患者血液HCV-RNA呈阳性。总体而言,63%的C-CLD患者检测到CGs,但与肝脏组织学结果相比,F3期患者中CGs检出率为88%,A3期为92%,因此在肝纤维化进展患者和活动度高的患者中检出率较高。CGs阳性患者的血清IgG、IgM、转氨酶和γ-GTP水平显著更高,其类风湿因子(RA)检测和C3d循环免疫复合物(C3dCIC)水平也往往更高,但差异不显著,且与抗核抗体阳性水平、HCV-RNA滴度或基因型无关联。基于上述情况,在日本,HCV感染也明显参与了CGs的形成,尤其是肝炎的活动度和组织学进展,但肝外表现较少,这表明与西方国家的病例相比,CGs水平及对CGs的免疫反应存在差异。