文献简介

出版社:Kidney International

作  者:Edgar D. Charles, and Lynn B. Dustin

编  号:10.1038/ki.2009.247

关键字:B cells, cryoglobulinemia, HCV,lymphoma,rheumatoid factor,vasculitis

年  份:2009   点击量:803

文献摘要

In this review we discuss the clinical manifestations, pathogenesis, and treatment of hepatitis C virus(HCV)–related cryoglobulinemia. HCV is a major cause of liverrelated morbidity and is increasingly recognized as an instigator of B-cell lymphoproliferative disorders such as mixed cryoglobulinemia and non-Hodgkin lymphoma. Cryoglobulinemia is characterized by the clonal expansion of rheumatoid factor–expressing B cells in the liver, lymph nodes, and peripheral blood, resulting in the presence of cryoglobulins in the circulation. Cryoglobulins are coldinsoluble immune complexes containing rheumatoid factor, polyclonal IgG, and HCV RNA that precipitate and deposit onvascular endothelium, causing vasculitis in organs such as the skin, kidneys, and peripheral nerves. A subset of patients develops a low-grade lymphoma composed of B cells that are immunophenotypically similar to the expanded B cells seen in cryoglobulinemia. HCV-related B-cell lymphoproliferative disorders likely comprise a spectrum of disease, ranging from asymptomatic clonal B-cell expansions to pathogenic cryoglobulinemia and lymphoma. It is unclear how B cells become dysregulated during the course of chronic HCV infection, and continued patient-centered research is necessary to elucidate the pathogenesis of HCV-related B-cell dysregulation.