Abstract：
The infection caused by the hepatitis C virus (HCV) is a significant global health concern. The prevailing genotype of HCV in Egypt is 4a, commonly referred to as GT-4a. A significant proportion exceeding 50% of patients infected with HCV experience extrahepatic manifestations (EHMs), encompassing a diverse range of clinical presentations. These manifestations, including essential mixed cryoglobulinemia (MC), can serve as initial and solitary indicators of the disease. The complete understanding of the pathogenesis of EHM remains unclear, with autoimmune phenomena being recognized as the primary causative factor. In this study, we examined the predictive significance of T-cell subpopulations in relation to the occurrence and prognosis of cryoglobulinemia in HCV patients. A total of 450 CHC genotype four treatment naïve patients were enrolled in this analytic cross-sectional study after thorough clinical, laboratory, and radiological examinations. All patients underwent laboratory investigations, including testing for cryoglobulin antibodies and measurements of CD4 and CD8 levels; two groups were described according to their test results: Group 1 consists of patients who have tested positive for cryoglobulin antibodies and Group 2 consists of patients who have tested negative for cryoglobulin antibodies. The exclusion criteria encompassed individuals with HIV infection or chronic HBV infection. Additionally, pelvi-abdominal ultrasonography was performed. Our study included 450 treatment naïve CHC patients (59% male, mean age 50.8 years). The patients were categorized according to their cryoglobulin antibodys test results into two groups: group A, CHC patients with cryoglobulin antibodies (Abs) negative (364 patients), and group B, CHC patients with cryoglobulin Ab positive (86 patients). Group B demonstrated a higher average age, elevated international normalized ratio, more prolonged duration of HCV infection, lower albumin, higher alanine aminotransferase, higher aspartate aminotransferase, higher bilirubin, lower CD8, lower CD4, and lower CD4:CD8 ratio. In contrast, 27 out of 86 (31.40%) patients in group B had symptoms; 85.8% had purpura and arthralgia, 74.3% had paresthesias, 86.7% had weakness, and 12.2% had non-Hodgkin\'s lymphoma. The levels of CD4 and CD8 were found to be decreased in chronic HCV patients with MC. T-cell subpopulation serves as a reliable indicator for assessing the prevalence and prognosis of MC in individuals with genotype 4 chronic hepatitis C. However, additional research is needed to further understand the development and spread of various emerging infectious diseases. Nevertheless, it is noteworthy that a critical threshold may exist beyond which EHM reaches a point of no return.
摘要：
丙型肝炎病毒（HCV）引起的感染是一个重要的全球健康问题。埃及流行的HCV基因型是4a，通常称为GT-4a。显著比例超过50%的感染HCV的患者经历肝外表现（EHM），包括各种临床表现。这些表现，包括原发性混合型冷球蛋白血症（MC），可以作为疾病的初始和单独指标。对EHM发病机制的完整理解仍不清楚，自身免疫现象被认为是主要的致病因素。在这项研究中,我们研究了T细胞亚群对HCV患者冷球蛋白血症发生和预后的预测意义.共有450个CHC基因型四治疗初治患者被纳入这项分析性横断面研究后，彻底的临床，实验室,和放射学检查。所有患者都接受了实验室检查，包括冷球蛋白抗体检测和CD4和CD8水平测量;根据检测结果对两组进行了描述:第1组由冷球蛋白抗体检测阳性的患者组成,第2组由冷球蛋白抗体检测阴性的患者组成.排除标准包括HIV感染或慢性HBV感染的个体。此外,进行盆腔腹部超声检查。我们的研究包括450名初治CHC患者（59%为男性，平均年龄50.8岁)。根据冷球蛋白抗体测试结果将患者分为两组：A组，冷球蛋白抗体（Abs）阴性的CHC患者（364例患者），B组,冷球蛋白Ab阳性的CHC患者（86例）。B组表现出更高的平均年龄，国际标准化比率提高，HCV感染的持续时间更长，低白蛋白,高级丙氨酸氨基转移酶，高级天冬氨酸转氨酶，胆红素较高，较低的CD8，较低的CD4和较低的CD4：CD8比率。相比之下,B组86例患者中有27例(31.40%)有症状；85.8%有紫癜和关节痛，74.3%有感觉异常，86.7%有弱点，12.2%患有非霍奇金淋巴瘤。发现患有MC的慢性HCV患者的CD4和CD8水平降低。T细胞亚群是评估基因型4慢性丙型肝炎患者MC患病率和预后的可靠指标。需要更多的研究来进一步了解各种新出现的传染病的发展和传播。然而，值得注意的是，可能存在一个临界阈值，超过该阈值，EHM达到了无回报点。
