PDF(Pubmed)
Abstract：
Mixed cryoglobulinemia vasculitis (MCV) is caused in ~90% of cases by chronic hepatitis C virus (HCVposMCV) and more rarely by hepatitis B virus (HBV) infection, or apparently noninfectious. HCVposMCV develops in only ~5% of patients with chronic hepatitis C (CHC), but risk factors other than female gender have not been identified so far. We conducted a retrospective case control study investigating whether past active HBV infection, defined by hepatitis B surface antigen (HBsAg) seroclearance and anti-core antibody (HBcAb) positivity, could be a risk factor for developing HCVposMCV. The prevalence of HBsAg seroclearance was 48% within 123 HCVposMCV patients and 29% within 257 CHC patients (p=0.0003). Multiple logistic regression including as variables gender, birth year, age at HBV testing, cirrhosis, and hepatocellular carcinoma, confirmed an association of HBsAg seroclearance with HCVposMCV [adjusted odds ratio (OR) 2.82, 95% confidence interval (95% CI) 1.73-4.59, p<0.0001]. Stratification by gender, however, showed that HBsAg seroclearance was associated with HCVposMCV in male [OR 4.63, 95% CI 2.27-9.48, p<0.0001] and not in female patients [OR 1.85, 95% 95% CI 0.94-3.66, p=0.076]. HBsAg seroclearance, and more likely occult HBV infection, is an independent risk factor for HCVposMCV in male CHC patients.
摘要：
混合性冷球蛋白血症血管炎（MCV）约90％的病例由慢性丙型肝炎病毒（HCVposMCV）引起，很少由乙型肝炎病毒（HBV）感染引起。或者显然是非传染性的。HCVposMCV仅在约5％的慢性丙型肝炎（CHC）患者中发展，但是到目前为止，尚未发现女性以外的危险因素。我们进行了一项回顾性病例对照研究，调查过去是否活动性HBV感染，由乙型肝炎表面抗原（HBsAg）血清清除和抗核心抗体（HBcAb）阳性定义，可能是发展HCVposMCV的危险因素。HBsAg血清清除的患病率在123例HCVposMCV患者中为48％，在257例CHC患者中为29％（p=0.0003）。多元逻辑回归包括作为变量的性别，出生年份,年龄在HBV检测，肝硬化,和肝细胞癌，证实了HBsAg血清清除与HCVposMCV的关联[调整比值比（OR）2.82，95％置信区间（95％CI）1.73-4.59，p<0.0001]。按性别分层，然而,显示HBsAg血清清除与男性患者的HCVposMCV相关[OR4.63，95％CI2.27-9.48，p<0.0001]，而不是女性患者[OR1.85，95％95％CI0.94-3.66，p=0.076]。HBsAg血清清除，更有可能隐匿性HBV感染，是男性CHC患者HCVposMCV的独立危险因素。
