Hepatitis C virus-induced cryoglobulinemia
Hepatitis C virus-induced cryoglobulinemia
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DOI：
10.1038/ki.2009.247
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发表时间：
2009-10-01
影响因子：
19.6
通讯作者：
Dustin, Lynn B.
中科院分区：
文献类型：
--
作者：
Charles, Edgar D.;Dustin, Lynn B.
本文综述了丙型肝炎病毒（HCV）相关冷球蛋白血症的临床表现、发病机制和治疗方法。HCV是肝脏相关疾病的主要原因，并且越来越被认为是b细胞淋巴细胞增殖性疾病（如混合冷球蛋白血症和非霍奇金淋巴瘤）的诱因。冷球蛋白血症的特点是肝脏、淋巴结和外周血中表达类风湿因子的B细胞克隆扩增，导致循环中存在冷球蛋白。冷球蛋白是一种含有类风湿因子、多克隆IgG和HCV RNA的冷不溶性免疫复合物，在血管内皮上沉淀和沉积，引起皮肤、肾脏和周围神经等器官的血管炎。一部分患者发展为由B细胞组成的低级别淋巴瘤，其免疫表型与在冷球蛋白血症中看到的扩增B细胞相似。hcv相关的b细胞淋巴增生性疾病可能包括一系列疾病，从无症状克隆性b细胞扩增到致病性冷球蛋白血症和淋巴瘤。目前尚不清楚B细胞在慢性HCV感染过程中是如何失调的，需要继续以患者为中心的研究来阐明HCV相关B细胞失调的发病机制。国际肾脏杂志（2009）76,818-824；doi: 10.1038 / ki.2009.247;2009年7月15日在线发布
In this review we discuss the clinical manifestations, pathogenesis, and treatment of hepatitis C virus (HCV)-related cryoglobulinemia. HCV is a major cause of liver-related morbidity and is increasingly recognized as an instigator of B-cell lymphoproliferative disorders such as mixed cryoglobulinemia and non-Hodgkin lymphoma. Cryoglobulinemia is characterized by the clonal expansion of rheumatoid factor-expressing B cells in the liver, lymph nodes, and peripheral blood, resulting in the presence of cryoglobulins in the circulation. Cryoglobulins are cold-insoluble immune complexes containing rheumatoid factor, polyclonal IgG, and HCV RNA that precipitate and deposit on vascular endothelium, causing vasculitis in organs such as the skin, kidneys, and peripheral nerves. A subset of patients develops a low-grade lymphoma composed of B cells that are immunophenotypically similar to the expanded B cells seen in cryoglobulinemia. HCV-related B-cell lymphoproliferative disorders likely comprise a spectrum of disease, ranging from asymptomatic clonal B-cell expansions to pathogenic cryoglobulinemia and lymphoma. It is unclear how B cells become dysregulated during the course of chronic HCV infection, and continued patient-centered research is necessary to elucidate the pathogenesis of HCV-related B-cell dysregulation. Kidney International (2009) 76, 818-824; doi:10.1038/ki.2009.247; published online 15 July 2009