Résumé
Several extrahepatic diseases have been associated with chronic HCV infection. Cytokines are peptides produced by the cells and play an important role in the defence against viral infections. The aim of our research is to investigate serum level of cytokines [IL1-beta, IL2, IL6 and IL8] in chronic HCV infected patients and find out the prevalence of primary Sjogren Syndrome [SS] and the relationship between disease severity and serum levels of these cytokines. This study included 60 patients [34 males and 26 females] with chronic virus C hepatitis, with mean age of 45 +/- 10.2 years and 20 healthy subjects [12 males and 8 females] with mean age 47 +/- 8.5 years as a control group. Biochemical assessment of hepatic condition and viral markers for hepatitis C virus [anti-HCV] and hepatitis B virus [HBs Ag and anti-HBc Ab], and serum levels of cytokines [IL1-beta, IL2, IL6 and IL8] were conducted to all patients. According to modified Child's criteria, the degree of liver affection was assessed for patients with chronic hepatitis. Liver biopsy was performed to confirm chronic liver hepatitis. Patients diagnosed having Sjogren Syndrome [SS] would further subjected to chest and hand X-ray, thyroid function tests and immunological study [anti-Ro, anti-La antibodies and Rhematoid factor]. There was highly significant elevation [p<0.0l] of interleukins 1, 2, 6 and 8, and ALT between patient and control groups. There were positive correlation between serum cytokines levels [IL1-beta, IL2, IL6] and liver function test ALT [p<0.05] and strong positive correlation between IL8 and ALT [p<0.0l]. Ten of sixty patients [16.6%] were diagnosed of having SS, 60% were males with mean age of 48 +/- 4.5 years. A highly significant direct correlation was found as regards number of swollen joints, duration of morning stiffness and serum levels of cytokines [IL1- beta, IL-2, 6 and IL-8]. High liters of anti Ro and anti La antibodies were associated with higher levels of interleukin 6. Eight patients showed evidence of hypothyroidism and four patients showed evidence of peripheral neuropathy. Cytokines and free radicals are thought to be responsible for the pathologic changes, but the precise mechanisms are not clear. The significant correlations between the severity of different clinical and laboratory parameters of SS and serum levels of cytokines can be explained by the assumption that proinflammatory cytokines inhibit neurally mediated lacrimal gland secretion as well as, in glandular epithelial cells the local production of cytokines by both mononuclear and epithelial cells may be involved in the immune-mediated destruction of exocrine glands in patients with primary SS. It is concluded that in chronic hepatitis C infection there is significant elevation of serum cytokines [IL1-beta, IL2, IL6 and IL8], and there is high prevalence rate of primary Sjogren Syndrome, specially in males of old age. The severity of SS clinical picture and laboratory diagnostic markers is directly correlated to the serum levels of those cytokines