慢性丙型肝炎患者普遍存在肝外表现

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Extrahepatic Manifestations Common in Patients With Chronic HCV
慢性丙型肝炎患者普遍存在肝外表现

NEW YORK (Reuters Health) Jan 29 - Extrahepatic manifestations are prevalent in Bulgarian patients with chronic hepatitis C infection, particularly in those with long-standing infections and those with advanced liver fibrosis, according to a recent study.
纽约（路透社 健康）1月29日，根据一项研究显示，在丙型肝炎病毒慢性感染的保加利亚患者中，肝外表现十分普遍，尤其是长期病毒携带和进展期肝纤维化患者。

Most such manifestations are the consequence of impaired lymphoproliferation and are associated with cryoglobulin production, the study team reports in the December 28 issue of the World Journal of Gastroenterology. At least some patients present with extrahepatic manifestations even in the absence of a clear clinical presentation of hepatic disease.
世界胃肠病学杂志，11月28日的一篇研究报道，这些肝外表现大多数都是淋巴组织增生和相关的冷球蛋白产物的结果。一些患者在还没有明确的肝病临床表现的时候就已经表现出一些肝外表现了。

Dr. Diana V. Stefanova-Petrova of University Hospital Alexandrovska, Sofia, Bulgaria, and colleagues reviewed the medical records of 136 patients with chronic hepatitis C virus (HCV) infection who were referred to that hospital between 1996 and 2004. The most common reason for referral was elevated liver enzymes.
保加利亚，索非亚Alexandrovska大学医院的Dr. Diana V. Stefanova-Petrova和他的同时回顾了1996至2006年住院的慢性丙型肝炎病毒感染的136名患者的医疗档案。他们主要是因为肝脏酶学水平升高入院。

At least one extrahepatic symptom or comorbidity was identified in 104 (76.5%) of the patients. The most frequent clinical manifestation was fatigue (59.6%), followed by kidney impairment (25.0%), type 2 diabetes (22.8%), paresthesia (19.9%),and arthralgia (18.4%). Other associated conditions were palpable purpura, predominantly of the lower extremities (17.6%), lymphadenopathy (16.2%), pulmonary fibrosis (15.4%), thyroid dysfunction (14.7%), Raynaud's phenomenon (11.8%), B-cell non-Hodgkin's lymphoma (8.8%), sicca-syndrome (6.6%), and lichen planus (5.9%).
这136人中有104人 (76.5%)至少可以确定有一项肝外表现或者伴随病，最常见的临床表现为疲乏(59.6%)，之后依次为肾脏损害(25.0%)，2型糖尿病(22.8%)，感觉异常(19.9%)，关节痛(18.4%)。其他相关的情况有可触知的紫癜，主要是以下肢为主(17.6%)，淋巴结病(16.2%)，肺纤维化(15.4%)，甲状腺功能不全(14.7%)，雷诺氏现象(11.8%)，B细胞非何杰金氏淋巴瘤(8.8%)，干燥综合症(6.6%)，扁平苔藓(5.9%)。

Laboratory findings showed these patients had cryoglobulinemia (37.5%), thrombocytopenia (31.6%), antinuclear antibodies (ANA) (18.4%), anti-smooth muscle antibodies (ASMA) (16.9%), anti-neutrophil cytoplasm antibodies (ANCA) (13.2%) and anti-cardiolipin antibodies (8.8%). The ANA, ASMA and ANCA were present in low titers.
这些患者的实验室检查可以发现冷球蛋白血症(37.5%)，血小板减少(31.6%)，抗核抗体(ANA) (18.4%)，抗平滑肌细胞抗体(ASMA) (16.9%)，抗中性粒细胞胞浆抗体(ANCA) (13.2%)和抗心肌磷脂抗体(8.8%)，其中ANA, ASMA and ANCA呈低水平表达。

The factors most significantly associated with extrahepatic manifestations were long duration of HCV infection (at least 20 years versus less than 20 years, P = 0.001) and advanced liver fibrosis (Metavir F4, P = 0.011).
和肝外表现关系最密切的影响因素是HCV感染的持续时间（对比20年以上包括20年和20年以下组，P = 0.001)和肝纤维化的进展(Metavir F4, P = 0.011)。

The findings are consistent with those previously published on French, Italian and American HCV patients and also suggest that \"the dose of the virus and the route of transmission may be important factors associated with extrahepatic manifestations,\" Dr. Stefanova-Petrova and associates point out.
Dr. Stefanova-Petrova和同伴指出结果和以前公布的在法国，意大利和美国丙型肝炎患者中的研究结果一致，这就说明提示“病毒含量和传播途径可能是影响肝外表现的重要因素”。

The researchers note that \"physicians should be aware of the extrahepatic signs and symptoms of HCV infection\" and should test for HCV in all patients with these manifestations.
研究人员解释，“医生应该注意HCV感染的肝外体征和症状”应该给具有这些症状的所有患者检查HCV。

World J Gastroenterol 2007;13:6518-6528.
世界胃肠病学杂志 2007;13:6518-6528