The interaction of morphological changes in the liver with the development of extrahepatic manifestations in patients with chronic hepatitis C

Authors

  • Yu. Yu. Riabokon Zaporizhzhia State Medical University, Ukraine,
  • V. A. Tumanskiy Zaporizhzhia State Medical University, Ukraine,
  • E. V. Riabokon Zaporizhzhia State Medical University, Ukraine,

DOI:

https://doi.org/10.14739/2310-1237.2018.1.129194

Keywords:

chronic hepatitis C, immunohistochemistry, extrahepatic manifestations

Abstract

The purpose of the work was to analyze the connections of morphological changes in the liver with the manifestation of clinical signs of extrahepatic manifestations in patients with CHC.

Material and methods. The study included 86 patients with CHC. The correlation analysis of expressiveness degree of liver fibrosis and histological activity depending on the presence of clinical signs of extrahepatic manifestations of disease and changes of autoimmune parameters was carried out.

Results. It was found that the incidence of mixed cryoglobulins in the blood of patients with CHC had a dependence on the degree of fibrosis of the liver. In the presence of liver fibrosis F 3–4 mixed cryoglobulins were found in 94.2 % versus 64.7 % of patients with stages of liver fibrosis F 12 (P < 0.01). In patients with stages of liver fibrosis F 3–4, the quantitative content of mixed cryoglobulins, RF-IgM and CIC was higher than those of patients with stages of liver fibrosis F 1–2. In patients with fibrosis in the liver F 3–4 cryoglobulinema incidence of vasculitis with formation of Meltzer’s triad was higher than in patients with liver fibrosis F 1–2 (19.2 % versus 2.9 %, P < 0.05). Content of mixed cryoglobulins correlated with the degree of fibrosis of the liver (r= +0.49, P < 0.01). A factor A3 was more often detected in patients with stage F 3–4, compared with patients with stage F 1–2 of fibrosis (81.5 % versus 19,2 %, P < 0.01).

Conclusions. CHC patients with liver fibrosis F 3–4 are characterized with more frequent appearance of mixed cryoglobulins, higher content of RF-IgM and CIC in serum than in patients with liver fibrosis F 1–2. This explains the higher frequency of clinical manifestations of extrahepatic manifestations of immunocomplex genesis in patients with F 3–4 fibrosis. Histological activity of A3 in patients with CHC is most often combined with fibrosis of the liver F 3–4, which causes a high frequency of cryoglobulinemic vasculitis development in these patients.

References

Negro, F., Forton, D., Craxì, A., Sulkowski, M., Feld, J. J., & Manns, M. P. (2015) Extrahepatic Morbidity and Mortality of Chronic Hepatitis C. Gastroenterology, 149(6), 1345–1360. doi: 10.1053/j.gastro.2015.08.035.

Roccatello, D., Sciascia, S., Rossi, D., Solfietti, L., Fenoglio, R., Menegatti, E., & Baldovino, S. (2017) The challenge of treating hepatitis C virus-associated cryoglobulinemic vasculitis in the era of anti-CD20 monoclonal antibodies and direct antiviral agents. Oncotarget, 8(25), 41764–41777. doi: 10.18632/oncotarget.16986.

Allison, R. D., Tong, X., Moorman, A. C., Ly, K. N., Rupp, L., Xu, F., et al. (2015) Increased incidence of cancer and cancer-related mortality among persons with chronic hepatitis C infection, 2006–2010. Journal of Hepatology, 63(4), 822–828. doi: 10.1016/j.jhep.2015.04.021.

Agnello, A. (1997) Hepatitis C virus infection and type II cryoglobulinemia: an immunological perspective. Journal of Hepatology, 26(6), 1375–1379. doi: 10.1053/jhep.1997.v26.ajhep0261375.

Yang, D. H., Ho, L. J., & Lai, J. H. (2014) Useful biomarkers for assessment of hepatitis C virus infectious-associated autoimmune disorders. World Journal Gastroenterology, 20(11), 2962–2970. doi: 10.3748/wjg.v20.i11.2962.

Cacoub, P., Comarmond, C., Domont, F., Savey, L., Desbois, A. C., & Saadoun, D. (2016) Extrahepatic manifestation of chronic hepatitis virus infection. Therapeutic Advances in Infectious Disease, 3(1), 3–14. doi: 10.1177/2049936115585942.

Milovanova, S. Yu., Kozlovskaya, L. V., & Gordovskaya, N. B. (2014) Polimorfizm klinicheskikh proyavlenij krioglobulinemicheskogo vaskulita, associirovannogo s khronicheskim gepatitom C [Polymorphism of clinical manifestations of cryoglobulinemia-related vasculitis associated with chronic hepatitis С virus infection]. Al'manakh klinicheskoj mediciny, 30, 46–51. [in Russian].

Atta, A. M., Oliveira, I. S., Sousa, G. M., Paraná, R., & Atta, M. L. (2010) Serum cytokine profile in hepatitis C virus carriers presenting cryoglobulinaemia and nonorgan-specific autoantibodics. Microbial Pathogenesis, 48, 53–56. doi: 10.1016/j.micpath.2009.12.002.

Saadoun, D., Asselah, T., Resche-Rigon, M., Charlotte, F., Bedossa, P., Valla, D., et al. (2006) Cryoglobulinemia is associated with steatosis and fibrosis in chronic hepatitis C. Journal of Hepatology, 43(6), 1337–1345. doi: 10.1002/hep.21190.

Andrade, L. J., Santana de Melo, P. R., Atta, A. M., Atta, M. L., Jesus, L. S., Sousa, G. M., et al. (2011) Smooth muscle antibodies and cryoglobulinemia are associated with advanced liver fibrosis in Brazilian hepatitis C virus carriers. Brazilian Journal of Infectious Diseases, 15(1), 66–8. doi: 10.1016/S1413-8670(11)70142-8.

Dunaeva, N. V., Karev, V. E., Vorobyeva, O. A., Mazing, A. V., Lapin, S. V., Smirnov, A. V., & Gusev, D. A. (2016) Protivovirusnaya terapiya khronicheskogo gepatita C, oslozhnennogo sistemnym krioglobulinemicheskim vaskulitom [Antiviral therapy of chronic hepatitis C, complicated by systemic cryoglobulinemic vasculitis]. Zhurnal infektologii, 8(2), 40–47. [in Russian].

Milovanova, S. Yu. (2013) Smeshannaya krioglobulinemiya, associirovannaya s khronicheskim gepatitom C: znachenie v razvitii vnepechenochnykh poyavleniy, metody lecheniya (Avtoref. dis… dokt. med. nauk) [Mixed cryoglobulinemia associated with chronic hepatitis C: significance in the development of extrahepatic events, methods of treatment. Dr. med. sci. diss.]. Moscow. [in Russian].

Gragnani, L., Visentini, M., Fognani, E., Urraro, T., De Santis, A., Petraccia, L., et al. (2016) Prospective study of guideline-tailored therapy with direct-acting antivirals for hepatitis c virusassociated mixed cryoglobulinemia. Journal of Hepatology, 64(5), 1473–1482. doi: 10.1002/hep.28753.

European Association for the Study of the Liver. (2015) EASL Recommendations on Treatment of Hepatitis C 2015. Journal of Hepatology, 63(1), 199–236. doi: 10.1016/j.jhep.2015.03.025.

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1.
Riabokon YY, Tumanskiy VA, Riabokon EV. The interaction of morphological changes in the liver with the development of extrahepatic manifestations in patients with chronic hepatitis C. Pathologia [Internet]. 2018May3 [cited 2024Apr.20];(1). Available from: http://pat.zsmu.edu.ua/article/view/129194

Issue

No. 1 (2018)

Section

Original research

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