Abstrakt

Cryoglobulinemia is a condition with a confirmed relationship with HCV infection, but many other extrahepatic symptoms are also present in hepatitis C. Cel: The aim of this study was to assess the incidence and type of extrahepatic manifestations and cryoglobulinemia as well as their correlation with clinical symptoms in Polish patients. Materiały i metody: 246 consecutive patients with hepatitis C were studied. Clinical symptoms were assessed by anamnesis and a clinical investigation. Cryoglobulins were estimated by a method basing on their ability to reverse precipitation in temperature +4ºC. Monoclonality of cryoglobulins was estimated by agarophoresis immunotyping – capillary electrophoresis and immunofixation. The presence of classical rheumatoid factor (RF-IgM) was tested using ELISA. Anti-nuclear antibodies (ANA) were tested using the indirect immunofluorescence method. Anti-CCP, anti-SSA, anti-α-fodrin antibodies, RF IgG, IgM and IgA were assessed using commercial enzymatic tests. Statistical methods were: Fisher exact test, generalized additive models, odds ratios with 95% confidence intervals, aid of spline curve, SAS system version 9.4. Wyniki: Cryoglobulins were found in 93 persons (37.8%). Type II cryoglobulinemia was detected in 28 persons. Patients with cryoglobulinemia were elder (p<0.0004). 54 patients (21.95%) manifested clinical extrahepatic symptoms. Arthralgia was found in 27 cases (10.98%). Skin changes were found in 22 patients (8.94%). 12 persons had glomerulonephritis (4.88%). 11 patients (4.47%) had sicca syndrome. 6 patients developed peripheral polyneuropathy (2.4%). 4 persons developed B cell lymphoma (1.63%). There was no correlation between presence of symptoms and grading, staging, age, HCV genotype, and the presence of autoantibodies. Extrahepatic manifestations were present more frequently in women (p<0.0008).

Przypisy

• 1. Adinolfi L.E., Utili R., Attanasio V., Zampino R.,Ragone E.,Tripodi M.F., Ruggiero G.: Epidemiology, clinical spectrum and prognostic value of mixed cryoglobulinaemia in hepatitis C virus patients: a prospective study. Ital. J. Gastroenterol., 1996; 28: 1-9
  Google Scholar
• 2. Brouet J.C., Clauvel J.P., Danon F., Klein M., Seligmann M.: Biologic and clinical significance of cryoglobulins. A report of 86 cases. Am. J. Med., 1974; 57: 775-788
  Google Scholar
• 3. Cacoub P., Gragnani L., Comarmond C., Zignego A.L.: Extrahepatic manifestations of chronic hepatitis C virus infection. Dig. Liver Dis., 2014; 46: S165-S173
  Google Scholar
• 4. Ferri C., Sebastiani M., Giuggioli D., Cazzato M., Longombardo G., Antonelli A., Puccini R., Michelassi C., Zignego A.L.: Mixed cryoglobulinemia: demographic, clinical, and serologic features and survival in 231 patients. Semin. Arthritis Rheum., 2004; 33: 355-374
  Google Scholar
• 5. Lunel F., Musset L., Cacoub P., Frangeul L., Cresta P., Perrin M., Grippon P., Hoang C., Valla D., Piette J.C., Huraux J.M., Opolon P.: Cryoglobulinemia in chronic liver diseases: role of hepatitis C virus and liver damage. Gastroenterology, 1994; 106: 1291-1300
  Google Scholar
• 6. Meltzer M., Franklin E.C., Elias K., McCluskey R.T., Cooper N.: Cryoglobulinemia – a clinical and laboratory study. II. Cryoglobulins with rheumatoid factor activity. Am. J. Med., 1966; 40: 837-856
  Google Scholar
• 7. Pawełczyk A.: Cosequences of extrahepatic manifestations of hepatitis C viral infection (HCV). Postępy Hig. Med. Dośw., 2016; 70: 349-359
  Google Scholar
• 8. Ramos-Casals M., Stone J.H., Cid M.C., Bosch X.: The cryoglobulinaemias. Lancet, 2012; 379: 348-360
  Google Scholar
• 9. Sene D., Ghillani-Dalbin P., Thibault V., Guis L., Musset L., Duhaut P., Poynard T., Piette J.C., Cacoub P.: Longterm course of mixed cryoglobulinaemia in patients infected with hepatitis C virus. J. Rheumatol., 2004; 31: 2199-2206
  Google Scholar
• 10. Trejo O, Ramos-Casals M., Garcia-Carrasco M., Yagüe J., Jiménez S., de la Red G., Cervera R., Font J., Ingelmo M.: Cryoglobulinemia: study of etiologic factors and clinical and immunologic features in 443 patients from a single center. Medicine, 2001; 80: 252-262 The authors have no potential conflicts of interest to declare.
  Google Scholar

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