Sjogren syndrome associated with hepatitis C virus - A multicenter analysis of 137 cases
Sjogren syndrome associated with hepatitis C virus - A multicenter analysis of 137 cases
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DOI：
10.1097/01.md.0000157397.30055.c9
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发表时间：
2005-03-01
期刊：
影响因子：
1.6
通讯作者：
Font, J
中科院分区：
文献类型：
--
作者：
Ramos-Casals, M;Loustaud-Ratti, V;Font, J
为明确慢性丙型肝炎病毒（HCV）感染相关的干燥综合征（SS）的临床和免疫学表达模式，我们进行了一项多中心研究，旨在收集大量SS和HCV感染患者。入选标准为至少符合欧洲共同体研究组提出的SS分类标准中的4项，并经重组免疫印迹试验和/或聚合酶链反应检测血清HCV-RNA证实的HCV血清学重复阳性。共纳入137例患者（104例女性和33例男性;平均年龄65岁）。79例（58%）患者表现为全身性过程，伴有不同的腺外表现，关节受累（44%）、血管炎（20%）和神经病变（16%）是观察到的最常见特征。主要免疫学特征为抗核抗体（65%）、低补体血症（51%）和冷球蛋白血症（50%）。cryobulins与皮肤血管炎、类风湿因子和低补体血症的发生率较高相关。32例（23%）患者抗Ro/SS-A和/或抗La/SS-B抗体阳性;这些患者主要为女性，且某些腺体外特征的患病率较高，肝脏受累的频率较低。19例（14%）患者发生肿瘤，其中血液肿瘤（8例）和肝细胞癌（6例）是最常见的类型。85%的SS-HCV患者也符合最近提出的2002年SS的分类标准。总之，HCV相关的SS在大多数情况下是无法区分的主要形式使用最新的一套分类标准。慢性HCV感染应被视为原发性SS分类的排除标准，不是因为它与原发性SS相似，而是因为该病毒可能与特定患者亚组的SS发生有关。当这些患者符合2002年SS分类标准时，我们提出术语“继发于HCV的SS”。
To define the clinical and immunologic pattern of expression of Sjogren syndrome (SS) associated with chronic hepatitis C virus (HCV) infection, we conducted a multicenter Study aiming to collect a large number of patients with SS and HCV infection. Inclusion criteria were the fulfillment of at least 4 of the classification criteria for SS proposed by the European Community Study Group and repeated positive HCV serology, confirmed by recombinant immunoblot assay and/or detection of serum HCV-RNA by polymerase chain reaction. One hundred thirty-seven patients were included (104 female and 33 male; mean age, 65 yr). Seventy-nine (58%) patients presented a systemic process with diverse extraglandular manifestations, with articular involvement (44%), vasculitis (20%), and neuropathy (16%) being the most frequent features observed. The main immunologic features were antinuclear antibodies (65%), hypocomplementemia (51%), and cryoglobulinemia (50%). Cryoglobulins were associated with a higher frequency of cutaneous vasculitis, rheumatoid factor, and hypocomplementemia. Thirty-two (23%) patients had positive antiRo/SS-A and/or anti-La/SS-B antibodies; these patients were predominantly women and had a higher prevalence of some extraglandular features and a lower frequency of liver involvement. Nineteen (14%) patients developed neoplasia, with hematologic neoplasia (8 cases) and hepatocellular carcinoma (6 cases) being the most frequent types. Eighty-five percent of SS-HCV patients also fulfilled the recently proposed 2002 classification criteria for SS.In conclusion, HCV-associated SS is indistinguishable in most cases from the primary form using the most recent set of classification criteria. Chronic HCV infection should be considered an exclusion criterion for the classification of primary SS, not because it mimics primary SS, but because the virus may be implicated in the development of SS in a specific subset of patients. We propose the term "SS secondary to HCV" when these patients fulfill the 2002 classification criteria for SS.