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Z Gastroenterol 2009; 47(5): 446-456
DOI: 10.1055/s-0028-1109296
Übersicht

© Georg Thieme Verlag KG Stuttgart · New York

Extrahepatische Manifestationen der chronischen Hepatitis-C-Virus-Infektion

Extrahepatic Manifestations of Chronic Hepatitis C Virus InfectionK. P. Puchner1 , T. Berg1
  • 1Medizinische Klinik m. S. Hepatologie und Gastroenterologie, Charité, Campus Virchow-Klinikum, Universitätsmedizin Berlin
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Publication History

Manuskript eingetroffen: 21.12.2008

Manuskript akzeptiert: 19.2.2009

Publication Date:
05 May 2009 (online)

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Zusammenfassung

Die chronische HCV-Infektion wird heute als eine infektiöse Systemerkrankung verstanden. Mehr als die Hälfte der Patienten mit chronischer Hepatitis-C-Infektion entwickelt im Verlauf ihrer Erkrankung eine extrahepatische Manifestation. Nicht selten stellen extrahepatische Manifestationen den einzigen klinischen Hinweis auf eine chronische HCV-Infektion dar. Bei unklaren Symptomen bzw. Kranheitsbildern des rheumatischen, hämatologischen, endokrinen und dermatologischen Formenkreises sowie bei chronischer Müdigkeit und Abgeschlagenheit sollte immer eine HCV-Infektion ausgeschlossen werden. Der HCV-Lymphotropismus und die Bildung von Kryoglobulinen spielen in der Pathogenese der extrahepatischen Manifestationen eine besondere Rolle. Für zahlreiche der mit der HCV-Infektion beschriebene extrahepatische Manifestationen sind jedoch die pathogenetischen Mechanismen unklar. Die Eradikation der chronischen Virusinfektion mittels antiviraler Kombinationstherapie stellt die Behandlung der Wahl bei extrahepatischen Manifestationen dar. Meist besteht eine enge Korrelation zwischen virologischer und klinischer Response. In seltenen Fällen, insbesondere bei HCV-assoziierten Zytopenien und Neuropathien, kann es durch die antivirale Therapie zu einer Aggravation der extrahepatischen Manifestation kommen. Bei der Therapieentscheidung müssen deshalb die Form der Organbeteiligung sowie der Schweregrad und Verlauf der Erkrankung berücksichtigt werden. Immusuppressiva, Plasmapherese und in jüngster Zeit insbesondere auch Rituximab stellen wichtige weitere Therapieoptionen dar, die entweder alternativ oder komplementär eingesetzt werden können.

Abstract

Current data suggest that HCV infection should be regarded as a systemic infectious disease with multiorgan involvement. More than 50 % of HCV-positive patients develop during the course of the disease at least one extrahepatic manifestation (EHM). The EHMs are often the first and only clinical signs of a chronic hepatitis C. Evidence of HCV infection should always be sought out in cases of unspecific chronic fatigue and/or rheumatic, haematological, endocrine or dermatological disorders. Key pathogenetic factors for the development of EHM are undisputably the HCV lymphotropism and cryoglobulinaemia. Nevertheless, the exact pathogenesis of many EHM still remains unclear. The therapeutic approach to EHM should concentrate on the eradication of HCV. Antiviral therapy in the form of peg-interferon and ribavirin should be regarded as the first-line therapy. Viral response leads mostly to a consecutive clinical response. However, in the case of HCV-related cytopaenias or neuropathies, antiviral therapy may trigger an aggravation of these conditions. Thus, organ-involvement, severity and course of the EHM should be always taken into account when choosing the appropriate therapeutic strategy. Immunosuppressive drugs, plasmapheresis and lately rituximab are counted among therapies that can be applied complementarly or alternatively to the antiviral therapy.

Schlüsselwörter

Virushepatitis - Leber - Hepatitis C

Key words

viral hepatitis - liver - hepatitis C

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Prof. Dr. Thomas Berg

Medizinische Klinik m. S. Hepatologie und Gastroenterologie, Charité, Campus Virchow-Klinikum, Universitätsmedizin Berlin

Augustenburger Platz 1

13353 Berlin

Phone: + + 49/30/4 50 55 30 71

Fax: + + 49/30/4 50 55 39 03

Email: thomas.berg@charite.de