Interrelation of Immunological and Clinic-Morphological Parameters in Patients with Chronic Hepatitis C Depending on Mixed Cryoglobulinemia
Introduction. Mixed cryoglobulinemia is the most common extrahepatic manifestations of chronic HCV-infection. Questions about the role of cytokines and features of liver injury in patients with chronic HCV-infection with mixed cryoglobulinemia are debatable. Objective. To determine the interrelation between changes of immunological parameters (cryoglobulins, interferon-gamma, interleukin‑4) and clinic-morphological parameters in patients with chronic hepatitis C with mixed cryoglobulinemia. Materials and methods. Eighty two patients with chronic hepatitis C were examined. Stage of liver fibrosis was determined by morphological study of hepatic samples. Concentration of interferon-gamma and nterleykin‑4 was determined by enzyme immunoassay. Cryoglobulin level was determined by spectrophotometry. Results. In patients with mixed cryoglobulinemia low levels of interferon gamma and high levels of interleukin‑4 were detected in serum, the correlation between concentration of cryoglobulins and interferon gamma (r = –0.32; p < 0.05) and interleukin‑4 (r = 0.36; p < 0.05) was found. The higher level of mixed cryoglobulins was in patients with liver fibrosis F3–4 (p < 0.05). The greater frequency of clinical signs of cryoglobulinemic syndrome was registered in patients with liver fibrosis F3–4. Increasing concentration of mixed cryoglobulins was associated with the appearance of cryoglobulinemic syndrome symptoms (severe general weakness, skin purpura, Raynaud's syndrome) and their number and the severity of liver fibrosis. Enhanced level of interleukin‑4 is associated with the appearance of general weakness, skin purpura, and severe liver fibrosis. Conclusions. Increased level of mixed cryoglobulins is associated with the appearance of cryoglobulinemic syndrome symptoms, their number and with liver fibrosis severity. Increased interleukin‑4 correlates with the concentration of cryoglobulins, and is associated with the appearance of clinical manifestations cryoglobulinemic syndrome and with liver fibrosis F3–4. To improve the diagnosis course of chronic hepatitis C it is important to determine the concentration of cryoglobulins and interleukin‑4.
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