Résumé
Chronic hepatitis C virus [HCV] infection is associated with both pulmonary involvement and cryoglobulinemia. Therefore, this study was designed to investigate the relationship between pulmonary involvement and mixed cryoglobulinemia in chronic HCV infected patients and to investigate the role of TNF-alpha in the pathogenesis of pulmonary changes. After hospital ethics committee approval and formal patient consent were obtained, 100 patients with compensated hepatitis C virus infection as confirmed by PCR were recruited in this cross sectional study. Their demographic and laboratory data, abdominal ultrasound findings, pulmonary function tests [spirometry], arterial blood gas [ABG] parameters, TNF-alpha levels, and data from high-resolution chest CT were collected and analyzed using SPSS version 16, and a serum cryoglobulin assay was performed in all of the studied patients The prevalence of mixed cryoglobulinemia was 61.7% in the studied HCV patients. Pulmonary symptoms were observed in more than half of these patients. The most common complaint among the symptomatic patients was dyspnea [51.7%], followed by cough [43.3%]. Oxygen saturation [Spo[2] and Sao[2]%], and FEVi and FVC levels, were significantly decreased in the cryoglob-ulin positive patients compared to the cryoglobulin negative patients. A statistically significant correlation was found between the presence of cryoglobulins and FEV level, FVC level, serum albumin level, viremia level, thrombocytopenia and arterial blood gas parameters. No correlation was found between cryoglobulinemia and TNF-alpha level. The results of this study suggest that pulmonary involvement is common in patients with chronic HCV infection and mixed cryoglobulinemia. Cryoglobulinemia may lead to pulmonary involvement through vascular and interstitial deposition of cryoglobulins, which results in impaired gas exchange and airway affection
Sujets)
Maladie chronique , Cryoglobulinémie/sang , Prévalence , Échanges gazeux pulmonaires , Tests de la fonction hépatique , Tests de la fonction respiratoire , Alphafoetoprotéines , Réaction de polymérisation en chaîne , Test ELISA , Hôpitaux universitairesRésumé
Chronic hepatitis is characterised by increased regenerative cell proliferation, a process that makes cells more susceptible to gene mutations and development of hepatocellular carcinoma [HCC]. Evaluation of the proliferative index could be a useful tool for identifying patients at risk for HCC. The current study was planned to evaluate hepatocyte proliferation in predominant causes of chronic liver disease in an attempt to investigate predictors of proliferation. This study included 84 patients with chronic liver diseases, and they were classified into three groups: chronic hepatitis C [50 patients], non-alcoholic steatohepatitis [NASH] [20 patients] and chronic hepatitis B [14 patients]. All cases were investigated by liver function tests, polymerase chain reaction [PCR] hepatitis C virus [HCV] and hepatitis B virus [HBV], routine abdominal ultrasound and liver biopsy with detection of the proliferative index using the monoclonal antibody MIBI-Ki-67. The proliferative index was significantly higher in the chronic hepatitis C group than in the chronic hepatitis B group [P value = 0.007]. There were significant correlations of the Ki-67 index in both zone 1 and zones 2 and 3 with alanine aminotransferase [ALT], aspartate aminotransferase [AST] and histological activity index [HAI] score. Using the multiple regression analysis on the variables affecting proliferation, it was found that predictors of zone 1 proliferation were the following variables: ALT, age, AST and aetiological factor, in that order. HCV aetiology had significantly higher proliferation index, whereas NASH had the least. Increased HAI score is associated with higher proliferative index in either zone 1 or zones 2 and 3. Predictors of proliferation index in zone 1 were ALT, age, AST and aetiological factor