Extrahepatic manifestations of hepatitis C among United States male veterans
Extrahepatic manifestations of hepatitis C among United States male veterans
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DOI：
10.1053/jhep.2002.37191
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发表时间：
2002-12-01
期刊：
影响因子：
13.5
通讯作者：
Rabeneck, L
中科院分区：
文献类型：
--
作者：
El-Serag, HB;Hampel, H;Rabeneck, L
丙型肝炎病毒（HCV）与几种肝外疾病有关。到目前为止，大多数评估这些关联的研究只涉及少数患者，并且缺乏对照组。使用退伍军人事务部的计算机数据库，我们进行了一项以医院为基础的病例对照研究，检查了1992年至1999年期间住院的所有HCV感染患者（n = 34，204），并随机选择了与入院当年病例相匹配的无HCV对照组（n = 136，816）。在住院和门诊病例中检索了涉及皮肤（迟发性皮肤卟啉症[PCT]、白癜风和扁平苔藓）、肾脏（膜性肾小球肾炎[GN]和膜增生性肾小球肾炎）、血液学（冷球蛋白、霍奇金淋巴瘤和非霍奇金淋巴瘤[NHL]）、内分泌（糖尿病、甲状腺炎）和风湿性疾病（干燥综合征）的几种疾病。HCV和这些疾病之间的关联进行了多变量分析，控制年龄，性别，种族和兵役期间。病例组中的患者年龄更小（45岁vs 57岁），非白人更常见（39.6% vs 26.3%），男性更常见（98.1% vs 97.0%）。HCV感染患者中PCT、白癜风、扁平苔藓和冷球蛋白血症的比例明显较高。HCV感染者膜增生性肾小球肾炎的患病率更高，但膜性肾小球肾炎的患病率则不高。甲状腺炎、干燥综合征、霍奇金淋巴瘤或非霍奇金淋巴瘤的患病率无显著差异。然而，NHL在年龄调整后变得显著。糖尿病在对照组中比病例组更普遍，但在调整年龄后没有发现统计学显著相关性。总之，我们发现HCV感染与PCT、扁平苔藓、白癜风、冷球蛋白血症、膜增生性GN和NHL之间存在显著相关性。出现这些疾病的患者应进行HCV感染检测。
Hepatitis C virus (HCV) has been associated with several extrahepatic conditions. To date, most studies assessing these associations involved small numbers of patients and lacked a control group. Using the computerized databases of the Department of Veterans Affairs, we carried out a hospital-based case-control study that examined all cases of HCV-infected patients hospitalized during 1992 to 1999 (n = 34,204) and randomly chosen control subjects without HCV (n = 136,816) matched with cases on the year of admission. The inpatient and outpatient files were searched for several disorders involving the skin (porphyria cutanea tarda [PCT], vitiligo, and lichen planus); renal (membranous glomerulonephritis [GN] and membranoproliferative glomerulonephritis); hematologic (cryoglobulin, Hodgkin's and non-Hodgkin's lymphoma [NHL]); endocrine (diabetes, thyroiditis); and rheumatologic (Sjogren's syndrome). The association between HCV and these disorders was examined in multivariate analyses that controlled for age, gender, ethnicity, and period of military service. Patients in the case group were younger in age (45 vs. 57 years), were more frequently nonwhite (39.6% vs. 26.3%), and were more frequently male (98.1 % vs. 97.0%). A significantly greater proportion of HCV-infected patients had PCT, vitiligo, lichen planus, and cryoglobulinemia. There was a greater prevalence of membranoproliferative GN among patients with HCV but not membranous GN. There was no significant difference in the prevalence of thyroiditis, Sjogren's syndrome, or Hodgkin's or NHL. However, NHL became significant after age adjustment. Diabetes was more prevalent in controls than cases, but no statistically significant association was found after adjustment for age. In conclusion, we found a significant association between HCV infection and PCT, lichen planus, vitiligo, cryoglobulinemia, membranoproliferative GN, and NHL. Patients presenting with these disorders should be tested for HCV infection.