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。