tailieunhanh - Hepatology: A clinical textbook - Phần 2

Hepatology – A clinical textbook gives a comprehensive overview on the epidemiology, virology, and natural history of all hepatitis viruses including hepatitis A, D and E. Subsequent chapters cover all major aspects of the management of hepatitis B and C including coinfections with HIV and liver transplantation. | Extrahepatic Manifestations of Chronic HCV 323 15. Extrahepatic Manifestations of Chronic HCV Albrecht Bohlig Karl-Philipp Puchner and Thomas Berg Introduction Patients with chronic hepatitis C virus HCV infection are at risk of a variety of extrahepatic manifestations EHMs Table 1 - up to 70 of patients develop HCV EHMs according to large cohort studies Cacoub 2000 Cacoub 1999 . EHMs may often be the first and only clinical sign of chronic hepatitis C infection. Evidence of HCV infection should always be ruled out in cases of non-specific chronic fatigue and or rheumatic hematological endocrine or dermatological disorders. The pathogenesis of EHM is still not fully understood although most studies suggest that the presence of mixed cryoglobulinemia particularly HCV lymphotropism molecular mimicry and non-cryoglobulinemic autoimmune phenomena constitute the major pathogenic factors Ferri 2007 . Nevertheless the pathogenesis and epidemiology of many EHMs require further investigation Figure 1 . Our aim is to give a brief insight into the epidemiology pathogenesis clinical relevance and therapeutic management of HCV-associated EHM Zignego 2007a . Mixed cryoglobulinemia Cryoglobulinemia refers to the presence of abnormal immunoglobulins in the serum which have the unusual property of precipitating at temperatures below 37 C and redissolving at higher temperatures. The phenomenon of cryoprecipitation was first described in 1933 Wintrobe 1933 . Cryoglobulins CGs are nowadays classified into three types Table 2 based on their clonality. Type II CG and type III CG consisting of monoclonal and or polyclonal immunoglobulins are prevalent in patients with chronic HCV infection while type I CGs consisting exclusively of monoclonal components are mostly found in patients with lymphoproliferative disorders multiple myeloma B cell lymphoma Waldenstrom macroglobulinemia . Type II or type III mixed cryoglobulinemia is found in 19 -50 of patients with chronic HCV but leads to .

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• Hepatology a clinical textbook
• The epidemiology
• Management of HBV
• Management of hepatitis B
• Management of hepatitis C
• textbook
• clinical
• hepatology
• Stefan Mauss
• Thomas Berg
• Jürgen RockstrohChrist
• Hepatitis A
• Hepatitis B
• Hepatitis C
• Hepatitis E
• HBV Virology
• Intermediate metabolism
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• Intrahepatic lymphocytes
• Hepatocyte apoptosis
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• Management of acute viral hepatitis
• Acute hepatitis A
• Acute hepatitis B
• Acute hepatitis C
• Acute hepatitis E
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