الفهرس 
Hepatitis C VirusOnly 14 pages are availabe for public view
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Abstract
HCV is the most prevalent hepatotropic viruses worldwide, almost 80% of all infected patients develop chronic hepatitis followed by cirrhosis. chronic HCV infec-tion can result in stimulation of non organ specific autoanti-bodies (NOSAs), accumulation of immune complexes, and impairment of lymphoproliferation. All these mechanisms might trigger the development of immune mediated extrahe-patic disease.
Cryoglobulinemia is detected in one third of patients with HCV infection. Also, 70% to 80% of patients with MC are infected by HCV. It affects women three times more than men and usually occurs in middle age.
The striking association between HCV infection and type II mixed cryoglobulinemia (MC) has been well docu-mented. MC is a benign lymphoproliferative disorder and is regarded as a variant of low-grade B-NHL.
HCV has been regarded as a hepatotropic and lym-photropic virus that was demonstrated by PCR in not only serum/plasma and liver tissues but also in peripheral blood mononuclear cells (PBMCs) of patients infected with HCV. A number of reports have indicated that HCV infects CD81-positive lymphocytes, preferentially B cells.
Therefore, lymphotropism of HCV suggests that HCV could play a pathogenic role in the clonal proliferation of B cells because of the persistent stimulation of B cells by viral antigens and/or the enhanced expression of lymphomagene-sis-related genes that could be responsible for polyclonal and later to monoclonal expansion of B cells. Furthermore, the occurrence of a subsequent transformation may lead to B-NHL.
The aim of the present study was to evaluate the link between chronic HCV infection and development of B cell Non Hodgkin Lymphoma and its pathogenesis.
In the present study 90 subjects were included and clas-sified into 3 groups; group I included 30 chronic HCV in-fected patients without any evidence of lymphoma, group II included 30 chronic HCV associated B cell NHL patients, group III included 30 healthy controls.
All included patients were subjected to full history tak-ing with special stress on symptoms suggestive of lympho-ma, thorough clinical examination with special emphasis on lymph nodes, chest and abdominal examination, laboratory investigations including complete blood count, ESR, liver function tests, renal function tests, viral markers, cryoglobu-lins and B Lymphocyte Stimulator (BLyS) determination, and pelvi-abdominal ultrasound.
The results of the present study showed that BLyS had a sensitivity of 93.1%, specificity of 68.9% , a cut off value 900 pg/ml. It was positive (above the cut off value) in 19 pa-tients (63.3%), 28 patients (93.3%), 0 in group I, II and III respectively. Also, a strong association was found between cryoglobulinemia and positivity of BLyS as all patients who were cryoglobulins positive were BLyS positive. BLyS ranged from 2500-3500 pg/ml in group I, 4000-8000 pg/ml in group II and was negative in group III; indicating higher levels in patients with HCV and B cell NHL. So there was a highly statistically positive relation between BLyS and cryo-globulinemia.
There was a highly statistically positive relation between cryoglobulinemia and female gender in group I and II as 5 out of 6 cryoglobulins positive cases were females. Also, a highly positive relation with the presence of extra hepatic manifestations including renal, rheumatological and derma-tological.
Also the study reveals a positive correlation between levels of BLyS and age, hepatosplenomegaly, ESR, monocy-tosis, ALT level, ALP level, serum creatinine level, BUN and portal vein diameter by ultrasound. A negative correlation between BLyS levels and hemoglobin level, platelets, neu-trophils count and serum albumin.
Therefore BLyS can be used as a marker for develop-ment of B NHL in patients chronically infected with HCV and also it can be correlated with cryoglobulinemia in such setting.