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Chronic hepatitis C virus infection:Prevalence of extrahepatic manifestations and association with cryoglobulinemia in Bulgarian patients

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World Journal of Gastroenterology 2007年第48期13卷 6518-6528页

作者： Diana V Stefanova-Petrova anelia h tzvetanska Elisaveta J Naumova Anastasia P Mihailova Evgenii A hadjiev Rumiana P Dikova Mircho I Vukov Konstantin G Tchernev Department of Internal Diseases and Gastroenterology University Hospital Alexandrovska Viral Laboratory University Pediatric Hospital Central Laboratory of Immunology University Hospital Alexandrovska Department of hematology University Hospital Alexandrovska Department of Pathology University Hospital Alexandrovka National Centre for health Information

AIM: To assess the prevalence of extrahepatic manifestations in Bulgarian patients with chronic hepatitis C virus (hCV) infection and identify the clinical and biological manifestations associated with cryoglobulinemia. METhODS: The medical records of 136 chronically infected hCV patients were reviewed to assess the prevalence of extrahepatic manifestations. Association between cryoglobulin-positivity and other manifestations were identified using χ2 and Fisher’s exact test. Risk factors for the presence of extrahepatic manifestations were assessed by logistic regression analysis. RESULTS: Seventy six percent (104/136) of the patients had at least one extrahepatic manifestation. Clinical manifestations included fatigue (59.6%), kidney impairment (25.0%), type 2 diabetes (22.8%), paresthesia (19.9%), arthralgia (18.4%), palpable purpura (17.6%), lymphadenopathy (16.2%), pulmonary fi brosis (15.4%), thyroid dysfunction (14.7%), Raynaud’s phenomenon (11.8%), B-cell lymphoma (8.8%), sicca syndrome (6.6%), and lichen planus (5.9%). The biological manifestations included cryoglobulinproduction (37.5%), thrombocytopenia (31.6%), and autoantibodies: anti-nuclear (18.4%), anti-smooth muscle (16.9%), anti-neutrophil cytoplasm (13.2%) and anti-cardiolipin (8.8%). All extrahepatic manifestations showed an association with cryoglobulin-positivity, with the exception of thyroid dysfunction, sicca syndrome, and lichen planus. Risks factors for the presence of extrahepatic manifestations (univariate analysis) were: age ≥ 60 years, female gender, virus transmission by blood transfusions, longstanding infection (≥ 20 years), and extensive liver fi brosis. The most signifi cant risks factors (multivariate analysis) were longstanding infection and extensive liver fi brosis. CONCLUSION: We observed a high prevalence of extrahepatic manifestations in patients with chronic hCV infection. Most of these manifestations were associated with impaired lymphoproliferation and cryoglobulin produc

关键词： hepatitis C Liver cirrhosis Extrahepatic manifestations

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