Hepatitis C virus syndrome: A constellation of organ-and non-organ specific autoimmune disorders, B-cell nonHodgkin's lymphoma, and cancer  

作　　者：Clodoveo Ferri Marco Sebastiani Dilia Giuggioli Michele Colaci Poupak Fallahi Alessia Piluso Alessandro Antonelli Anna Linda Zignego 

机构地区：[1]Chair and Rheumatology Unit, Medical School,University of Modena and Reggio Emilia, Azienda OspedalieroUniversitaria, Policlinico di Modena [2]Department of Internal Medicine, School of Medicine, University of Pisa [3]Center for Systemic Manifestations of Hepatitis Viruses (MASVE), Department of Experimental and Clinical Medicine, University of Florence

出　　处：《World Journal of Hepatology》2015年第3期327-343,共17页世界肝病学杂志（英文版）（电子版）

摘　　要：The clinical course of chronic hepatitis C virus(HCV)infection is characterized by possible development of both liver and extrahepatic disorders. The tropism of HCV for the lymphoid tissue is responsible for several immune-mediated disorders; a poly-oligoclonal B-lymphocyte expansion, commonly observed in a high proportion of patients with HCV infection, are responsible for the production of different autoantibodies and immune-complexes, such as mixed cryoglobulins. These serological alterations may characterize a variety of autoimmune or neoplastic diseases. Cryoglobulinemic vasculitis due to small-vessel deposition of circulating mixed cryoglobulins is the prototype of HCV-driven immune-mediated and lymphoproliferative disorders; interestingly, in some cases the disease may evolve to frank malignant lymphoma. In addition, HCV shows an oncogenic potential as suggested by several clinicoepidemiological and laboratory studies; in addition to hepatocellular carcinoma that represents the most frequent HCV-related malignancy, a causative role of HCV has been largely demonstrated in a significant percentage of patients with isolated B-cells nonHodgkin's lymphomas. The same virus may be also involved in the pathogenesis of papillary thyroid cancer, a rare neoplastic condition that may complicate HCVrelated thyroid involvement. Patients with HCV infection are frequently asymptomatic or may develop only hepatic alteration, while a limited but clinically relevant number can develop one or more autoimmune and/or neoplastic disorders. Given the large variability of their prevalence among patients' populations from different countries, it is possible to hypothesize a potential role of other co-factors, i.e., genetic and/or environmental, in the pathogenesis of HCV-related extra-hepatic diseases.The clinical course of chronic hepatitis C virus （HCV）infection is characterized by possible developmentof both liver and extrahepatic disorders. The tropismof HCV for the lymphoid tissue is responsible forseveral immune-mediated disorders; a poly-oligoclonalB-lymphocyte expansion, commonly observed in ahigh proportion of patients with HCV infection, areresponsible for the production of different autoantibodiesand immune-complexes, such as mixed cryoglobulins.These serological alterations may characterize a varietyof autoimmune or neoplastic diseases. Cryoglobulinemicvasculitis due to small-vessel deposition of circulatingmixed cryoglobulins is the prototype of HCV-drivenimmune-mediated and lymphoproliferative disorders;interestingly, in some cases the disease may evolve tofrank malignant lymphoma. In addition, HCV shows anoncogenic potential as suggested by several clinicoepidemiologicaland laboratory studies; in addition tohepatocellular carcinoma that represents the mostfrequent HCV-related malignancy, a causative role ofHCV has been largely demonstrated in a significantpercentage of patients with isolated B-cells non-Hodgkin＇s lymphomas. The same virus may be alsoinvolved in the pathogenesis of papillary thyroid cancer,a rare neoplastic condition that may complicate HCVrelatedthyroid involvement. Patients with HCV infectionare frequently asymptomatic or may develop onlyhepatic alteration, while a limited but clinically relevantnumber can develop one or more autoimmune and/orneoplastic disorders. Given the large variability of theirprevalence among patients＇ populations from differentcountries, it is possible to hypothesize a potential role ofother co-factors, i.e. , genetic and/or environmental, inthe pathogenesis of HCV-related extra-hepatic diseases.

关 键 词：Hepatitis C virus Mixed CRYOGLOBULINEMIA THYROID Diabetes LYMPHOMA 

分 类 号：R593.2[医药卫生—内科学]