已显示两种嗜肝病毒与全身性血管炎-乙型肝炎与经典结节性多动脉炎和丙型肝炎与冷球蛋白性血管炎有因果关系。本文提供了有关这些血管炎的临床表现和管理的最新概述。HBV相关的PAN患者有较高的体重减轻,周围神经病变,多发性单神经炎,腹痛,需要手术的胃肠道表现,心肌病,睾丸炎,高血压,和/或转氨酶水平升高。微动脉瘤在肠系膜动脉中也更常见。皮肤表现,然而,不太常见。这些患者还患有严重的疾病,如通过较高的五因子评分和较高的BVAS所提示的。虽然复发不太常见,与非HBVPAN相比,HBVPAN患者的死亡率更高。血浆置换在清除免疫复合物的治疗中具有作用。HCV相关冷球蛋白血症性血管炎的常见临床表现为皮肤损害,周围神经病变,肾小球肾炎,关节炎,还有干燥症状.尽管聚乙二醇干扰素α和利巴韦林的联合治疗是一线治疗,对于严重或危及生命的表现,需要免疫治疗。最近的随机试验表明利妥昔单抗在这种情况下的疗效。
Two hepatotropic viruses have been shown to have causal relationship with systemic vasculitis-hepatitis B with classical polyarteritis nodosa and hepatitis C with cryoglobulinemic vasculitis. The present paper provides an updated overview on the clinical presentations and management of these vasculitides. HBV associated PAN patients have higher weight loss, peripheral neuropathy, mononeuritis multiplex, abdominal pain, gastrointestinal manifestations requiring surgery, cardiomyopathy, orchitis, hypertension, and/or elevated transaminase levels. Microaneurysms are also more common in mesenteric artery. Skin manifestations, however are less common. These patients also have a severe disease as suggested by higher five factor score and higher BVAS. Though relapses are less common, mortality is higher in patients with HBV PAN as compared to non HBV PAN. Plasmapheresis has a role in treatment in clearing off immune complexes. The common clinical manifestations of HCV associated cryoglobulinemic vasculitis are skin lesions, peripheral neuropathy, glomerulonephritis, arthritis, and sicca symptoms. Though combination therapy comprising of pegylated interferon α and ribavirin is the first line of management, immunotherapy is needed for severe or life threatening manifestations. Recent randomized trials have shown the efficacy of rituximab in such situations.