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7. Các biểu hiện ngoài gan | 79 Bảng 7.1 - HCV liên quan đến biểu hiện ngoài gan. Cơ quan / hệ thống nội tiết rối loạn tự miễn thyroidopathies Biểu hiện, đặc biệt, viêm tuyến giáp Hashimoto Kháng insulin / đái tháo đường * Mixed cryoglobulinaemia GH suy * * thần kinh ngoại biên viêm mạch Cryglobulinaemic | 7. Extrahepatic Manifestations 79 Table 7.1 - HCV-related extrahepatic manifestations. Organ System Manifestation Endocrine disorders Autoimmune thyroidopathies in particular Hashimoto thyroiditis Insulin resistance diabetes mellitus GH insufficiency Rheumatic disorders Mixed cryoglobulinaemia Cryglobulinaemic vasculitis Peripheral neuropathy Membranoproliferative glomerulonephritis GN Membranous GN Rheumatoid arthralgias oligo-polyarthritis Rheumatoid factor positivity Sicca syndrome Haemotologic disorders Lymphoproliferative disorders Non-Hodgkin Lymphomas Immune thrombocytopaenic purpura ITP Monoclonal gammopathies Autoimmune haemolytic anaemia Dermatologic disorders Palpable purpura Porphyria cutanea tarda PCT Lichen planus Pruritus Miscellaneous Chronic fatigue subclinical cognitive impairment psychomotoric deceleration symptoms of depression Myopathy Cardiomyopathy Myocarditis Idiopathic pulmonal fibrosis Associations with strong epidemiological prevalence and or clear pathogenetic mechanisms Lymphoproliferative Disorders Cryoglobulinaemia refers to the presence of abnormal immunoglobulins in the serum. Cryoglobulins CGs are classified into three types. Type II CG consisting of monoclonal and or polyclonal immunoglobulins are prevalent in patients with chronic HCV infection while type I CGs consisting exclusively of monoclonal components are mostly found in patients with lymphoproliferative disorders. Type II or type III mixed cryoglobulinaemia MC are found in 19 -50 of patients but This is trial version www.adultpdf.com 80 Hepatitis C Guide leads to clinical manifestations in only 30 of them Lunel 1994 Wong 1996 . Patients with symptomatic mixed cryoglobulinaemia exhibit higher cryoglobulin concentrations Weiner 1998 and lower concentrations of complement factors C3 and C4. Factors that seem to favour the development of MC are female sex age alcohol intake 50g d advanced liver fibrosis and steatosis Lunel 1994 Wong 1996 Saadoun 2006 . The diagnosis of MC .
