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Can we prevent and modify cardiometabolic disorders by controlling HCV infection?
Gut ( IF 24.5 ) Pub Date : 2017-07-13 , DOI: 10.1136/gutjnl-2017-314505
Salvatore Petta , Antonio Craxi

HCV infection has an estimated global prevalence of 1.0%, corresponding to roughly 71.1 million of infected individuals in 2015, with major geographical heterogeneity.1 Due to the large burden of infected individuals in the general population, the likelihood of co-occurrence of chronic HCV infection and common comorbidities is substantial regardless of causal linkages. Population-based studies show a higher overall mortality, both for liver-related and unrelated causes in HCV infected subjects compared with those uninfected, and cross-sectional and cohort studies identify HCV as an independent risk factor for extrahepatic manifestations.2 These issues are summarised in two meta-analyses reporting that HCV-infected patients are at higher risk of mixed cryoglobulinaemia, lymphoma, lichen planus, Sjogren’s syndrome, porphyria cutanea tarda, rheumatoid-like arthritis, depression, chronic kidney or end-stage renal disease, type 2 diabetes and cardiovascular disorders/mortality.3 4 While the link between HCV and some of these comorbidities—mixed cryoglobulinaemia, lymphoma and glomerulonephritis—is well established and driven by recognised pathophysiological mechanisms, the nature of the association between the infection and other common extrahepatic comorbidities is less clear. Clinical and experimental evidences suggest an intrinsic link between HCV infection and insulin-resistance/diabetes driven by the ability of the virus to interfere with insulin signalling, even if the strength of this association is not always confirmed. Emerging data also support a link between HCV infection and cardiovascular alterations. However, relative to this topic, contrasting data exist and the basis of this association stems on associative data, theoretical speculations and inconclusive experimental evidence.5 This mass of data and the recent availability of highly effective antiviral regimens, able …

中文翻译:

我们能否通过控制 HCV 感染来预防和改变心脏代谢紊乱?

HCV 感染的全球流行率估计为 1.0%,相当于 2015 年大约 7110 万感染者,具有重大的地域异质性。 1 由于一般人群中感染者的负担很大,慢性 HCV 并发的可能性无论因果关系如何,感染和常见的合并症都是相当大的。基于人群的研究表明,与未感染者相比,HCV 感染者的肝脏相关和非相关原因的总体死亡率更高,横断面和队列研究将 HCV 确定为肝外表现的独立危险因素。 2 总结了这些问题在两项荟萃分析报告中,HCV 感染患者患混合性冷球蛋白血症、淋巴瘤、扁平苔藓、干燥综合征、迟发性皮肤卟啉症的风险更高,类风湿性关节炎、抑郁症、慢性肾病或终末期肾病、2 型糖尿病和心血管疾病/死亡率。3 4 虽然 HCV 与其中一些合并症(混合性冷球蛋白血症、淋巴瘤和肾小球肾炎)之间的联系已得到充分证实和推动根据公认的病理生理机制,感染与其他常见肝外合并症之间关联的性质尚不清楚。临床和实验证据表明,由病毒干扰胰岛素信号传导的能力驱动的 HCV 感染和胰岛素抵抗/糖尿病之间存在内在联系,即使这种关联的强度并不总是得到证实。新出现的数据也支持 HCV 感染与心血管改变之间存在联系。但是,相对于这个话题,
更新日期:2017-07-13
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