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    Home > Active Ingredient News > Digestive System Information > One picture summary: the main extrahepatic manifestations of HBV infection

    One picture summary: the main extrahepatic manifestations of HBV infection

    • Last Update: 2022-01-26
    • Source: Internet
    • Author: User
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    Introduction Patients with chronic hepatitis B virus (HBV) infection have a higher incidence of liver complications, including end-stage liver disease and hepatocellular carcinoma (HCC)
    .

    Extrahepatic manifestations of HBV infection have long been underestimated, and knowledge and recognition of these manifestations are important for early diagnosis and treatment
    .

    This article summarizes the extrahepatic manifestations of HBV infection to guide clinical management
    .

    Summary in one figure: Major extrahepatic manifestations of HBV infection Figure 1 summarizes the major extrahepatic manifestations associated with HBV infection
    .

    Some of these extrahepatic syndromes have been reported, including polyarteritis nodosa (PAN) and other vasculitis, glomerulonephritis, and cutaneous manifestations
    .

    Several other extrahepatic manifestations, such as hematological and neurological lesions, have been recently reported
    .

    Figure 1.
    Major extrahepatic manifestations associated with HBV infection.
    Systemic disease serum sickness-like syndrome including arthritis, rash, angioedema, and fever

    .

    Arthritis symptoms lasted for about 20 days and disappeared when jaundice occurred
    .

    Arthritis can last until recovery
    .

    Mostly involving the proximal phalangeal joints, knee joints, ankle joints, shoulder joints, wrist joints, foot facet joints, elbow joints, cervical spine, hip joint and lumbar spine
    .

    There are various rashes, such as urticaria, maculopapular rash, erythema, petechiae,
    etc.

    PAN is a systemic necrotizing vasculitis involving medium-sized arteries and one of the more serious extrahepatic manifestations associated with chronic HBV infection
    .

    Patients with PAN typically present with poor general condition, arthralgia, myalgia, peripheral neuropathy, muscular atrophy, purpura, subcutaneous nodules, livedoids, and hypertension
    .

    In severe cases, the heart, intestines, lungs, and kidneys may also be involved
    .

    Mixed cryoglobulinemic vasculitis is a systemic vasculitis involving small and medium vessels
    .

    Modern immunology divides cryoglobulinemia into three types: type I, type II and type III
    .

    Most types II and III mixed cryoglobulinemia are primary, and secondary mixed cryoglobulinemia is mainly type III, which often occurs in infection, autoimmunity, and chronic liver disease
    .

    The patients mainly presented with glomerulonephritis, arthritis and purpura
    .

    Nephropathy Membranous glomerulonephritis and membranous proliferative glomerulonephritis are the most common types of glomerulopathy
    .

    In addition, HBV infection is also associated with focal glomerulosclerosis, minimal change nephropathy, and IgA nephropathy
    .

    There are strong epidemiological data for hematological disorders showing an association between chronic hepatitis B (CHB) and non-Hodgkin B-cell lymphoma (B-NHL)
    .

    Preliminary studies conducted in Asia found that the incidence of CHB was 2-5 times higher in patients with B-NHL than without B-NHL or the general population
    .

    More recent research supports this correlation
    .

    Two large North American databases showed that the relative risk of developing NHL in HBV-infected patients was 2.
    8

    .

    A Chinese case-control study showed that the pooled odds ratio for NHL in HBV-infected patients was 2.
    1

    .

    The underlying mechanisms underlying the increased risk of NHL in HBV-infected patients are currently unclear
    .

    Rheumatism in the prodromal stage of acute hepatitis B, about 20% -40% of patients with joint pain or arthritis, individual patients showed gastrocnemius pain and squeezing pain
    .

    Affected joints can be single or multiple, with wrist, elbow, and knee joints being more common, without severe pain, which is quite similar to migratory arthritis, and relieves or disappears with the improvement of hepatitis
    .

    Neurological disease HBV infection can also cause polyradiculitis or polyneuritis with Guillain-Barré syndrome, but damage to the central nervous system is rare
    .

    Other extrahepatic manifestations Notably, chronic HBV infection is associated with several other malignancies, including biliary tract, cervical, uterine, breast, thyroid, lung, and skin cancers
    .

    Pancreatic and ovarian cancers were more common in HBV-infected patients compared with NHL, a study from Taiwan showed
    .

    A recent prospective study in China involving 3 cohorts showed that HBV infection was highly associated with cancers of the digestive system, including gastric, oral, colorectal, and pancreatic cancers
    .

    References: [1] Cacoub P, Asselah T.
    Hepatitis B Virus Infection and Extra-Hepatic Manifestations: A Systemic Disease[J].
    Am J Gastroenterol.
    2021 Dec 16.
    doi: 10.
    14309/ajg.
    0000000000001575.
    [2] Liu Jie .
    Clinical research progress of HBV extrahepatic infection[J].
    Journal of Difficult and Difficult Diseases, 2007(09):569-571.
    [3] Pang Niande, Chen Anhai.
    Pantropic and extrahepatic infection of hepatitis B virus[J].
    China Health Industry, 2011, 8(07):121-122.
    DOI:10.
    16659/j.
    cnki.
    1672-5654.
    2011.
    07.
    047.
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