丙型肝炎病毒(HCV)感染是负责肝脏和肝外疾病(HCV-EHDs);这些后者在一方面清楚地与HCV淋巴功能引起的免疫系统失调以及与病毒致癌潜力,另一方面,慢性炎症状态可能导致心脏代谢并发症以及神经认知障碍。HCV-EHD的范围从轻度或中度表现,如关节痛,干燥综合征,周围神经病变,严重,危及生命的并发症,主要是血管炎和肿瘤。鉴于HCV-EHD的临床异质性,HCV感染的个体不可避免地根据呈现/流行的症状被转介给不同的专家;因此,全面的诊断指南的可用性对于患者的整体评估是必要的,这对于各种肝脏和HCV-EHD的早期诊断和正确的治疗方法是决定性的,无论不同医生或转诊中心的具体能力如何。在这方面,多学科专家网络,与丙型肝炎病毒感染相关的肝外表现国际研究小组(ISG-EHCV),旨在为可能的HCV-EHD的工作制定诊断指南。ISG-EHCV成员对拟议的指南达成了广泛共识,这基本上是基于两个主要水平的病人的评估。在转诊阶段,建议所有HCV感染患者均应通过一线诊断程序进行检查,包括病毒学和肝脏参数评估,以及可能提示一种或多种HCV-EHD的临床发现的检测。这项初步评估应揭示特定的HCV-EHD,这将通过二线进行更深入的分析,有针对性的调查。拟议的多学科专家声明代表了首次尝试为HCV感染者制定全面的诊断指南,涵盖了HCV相关疾病的整个范围。即典型的肝脏表现以及少见的表现,通常不可预测的HCV-EHD。HCV-EHD可能在很大程度上损害大量HCV感染个体的总体疾病结果,这使得他们的及时鉴定和治疗成为当务之急。总之,在HCV感染患者的转诊阶段以及随访期间,建议应用标准化但全面的HCV-EHD诊断指南.设想所提出的策略将导致此类患者的临床结果的改善。
Hepatitis C virus (HCV) infection is responsible for both hepatic and extra-hepatic disorders (HCV-EHDs); these latter are correlated on one hand clearly with HCV lymphotropism causing immune-system dysregulation as well as with viral oncogenic potential, and on the other hand probably with chronic inflammatory status causing cardio-metabolic complications as well as neurocognitive disturbances. The spectrum of HCV-EHDs ranges from mild or moderate manifestations, such as arthralgia, sicca syndrome, peripheral neuropathy, to severe, life-threatening complications, mainly vasculitis and neoplastic conditions. Given the clinical heterogeneity of HCV-EHDs, HCV-infected individuals are inevitably referred to different specialists according to the presenting/prevalent symptom(s); therefore, the availability of comprehensive diagnostic
guidelines is necessary for a patient\'s whole assessment that is decisive for early diagnosis and correct therapeutic approach of various hepatic and HCV-EHDs, regardless of the specific competencies of different physicians or referral centers. In this respect, a multidisciplinary network of experts, the International Study Group of Extrahepatic Manifestations Related to Hepatitis C Virus Infection (ISG-EHCV), was organized with the intention to formulate diagnostic
guidelines for the work-up of possible HCV-EHDs. There was a broad
consensus among ISG-EHCV members on the proposed
guidelines, which essentially are based on two main levels of patient\'s assessment. At the referral stage, it is proposed that all patients with HCV infection should be invariably examined by means of first-line diagnostic procedures including virological and hepatic parameter evaluation, as well as the detection of clinical findings that may suggest one or more HCV-EHDs. This preliminary assessment should reveal specific HCV-EHDs, which will be deeper analyzed by means of second-line, targeted investigations. The proposed multidisciplinary expert statement represents the first attempt to draw comprehensive diagnostic
guidelines for HCV-infected individuals encompassing the entire spectrum of HCV-related disorders, namely typical hepatic manifestations along with less common, often unpredictable HCV-EHDs. The HCV-EHDs may compromise to a substantial degree the overall disease outcome in a significant number of HCV-infected individuals that renders their timely identification and treatment an imperative. In conclusion, the application of standardized but thorough diagnostic
guidelines of HCV-EHDs is advisable at the referral stage as well as during the follow-up period of HCV infected patients. It is envisioned that the proposed strategy will result in improvement of clinical outcomes in such patients.