Rambusch E G, Manns M P
Abteilung Gastroenterologie und Hepatologie, Medizinische Hochschule Hannover.
Z Gastroenterol. 1998 Jul;36(7):579-86.
The hepatitis C virus is associated with various extrahepatic manifestations. It is unequivocal that hepatitis C is associated with mixed cryoglobulinemia, membranoproliferative glomerulonephritis, and in Southern Europe to some extend also with porphyria cutanea tarda. The rare combination of hepatitis C and panarteriitis nodosa is still questionable. The Sicca syndrome also seems to be associated with hepatitis C virus, but this is not the typical Sjögren syndrome. It is still unclear whether the rare combination of hepatitis C with aplastic enemia has pathogenetic aspects. Although an epidemiological association of hepatitis C with lichen planus, lymphoma, neuropathies and other diseases has been observed, the etiological role and the pathogenetic involvement of the hepatitis C infection remains unclear. Furthermore, the question whether these extrahepatic diseases observed are autoimmune diseases remains open. Concerning the practical approach in a clinical setting, it has to be pointed out that with these diseases a hepatitis C infection has to be considered and testing for hepatitis C antibodies and, if positive, hepatitis C-RNA is indicated. If there will be any evidence of an etiological association of a replicative hepatitis C infection and the mentioned extrahepatic diseases antiviral medication should be discussed.
丙型肝炎病毒与多种肝外表现相关。丙型肝炎与混合性冷球蛋白血症、膜增生性肾小球肾炎相关，在南欧还在一定程度上与迟发性皮肤卟啉症相关，这是明确无疑的。丙型肝炎与结节性多动脉炎的罕见组合仍存在疑问。干燥综合征似乎也与丙型肝炎病毒相关，但这并非典型的干燥综合征。丙型肝炎与再生障碍性贫血的罕见组合是否具有发病机制方面的因素仍不清楚。尽管已观察到丙型肝炎与扁平苔藓、淋巴瘤、神经病变及其他疾病存在流行病学关联，但丙型肝炎感染的病因学作用及发病机制参与情况仍不明确。此外，所观察到的这些肝外疾病是否为自身免疫性疾病这一问题也尚无定论。关于临床环境中的实际处理方法，必须指出的是，对于这些疾病必须考虑丙型肝炎感染，并进行丙型肝炎抗体检测，若结果为阳性，则需检测丙型肝炎病毒核糖核酸。如果有任何证据表明复制性丙型肝炎感染与上述肝外疾病存在病因学关联，则应讨论抗病毒治疗。
