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引起关节炎的特定病毒

Authors
Terry L Moore, MD
Reema Syed, MD
Section Editor
Peter H Schur, MD
Deputy Editor
Paul L Romain, MD
Translators
范彧, 副主任医师

引言

关节痛和/或关节炎是病毒感染中公认的且相对常见的事件。本专题将总结可引起关节炎症状的较为常见的病毒感染。病毒性关节炎的发病机制和诊断的概述参见其他专题。 (参见“病毒性关节炎的发病机制和诊断”)

甲型肝炎病毒

在甲型肝炎病毒(hepatitis A virus, HAV)感染中，关节痛和皮疹发生于10%-14%的患者，但关节炎极其罕见，且有人怀疑归因于HAV感染的关节炎患者事实上有丙型肝炎(hepatitis C virus, HCV)。主要在有慢性复发型甲型肝炎和高滴度多克隆IgG-和IgM-循环冷球蛋白(Ⅲ型冷球蛋白血症)的血管炎患者中描述了关节炎[1]。

乙型肝炎病毒

乙型肝炎病毒(hepatitis B virus, HBV)感染个体可以有症状或无症状。无症状性感染比症状性感染更常见，尤其在年幼儿童中。成人中大多数原发感染呈自限性，病毒从血液和肝脏中被清除并且产生对再感染的持久免疫力[2,3]。然而，健康成人的一些原发感染(通常少于5%)不会消退，而是发展成持续性感染。原发感染的血清学证据证明了这一点：出现乙型肝炎表面抗原(hepatitis B surface antigen, HBsAg)，紧接着出现抗HBV核心抗原的IgM抗体(抗HBc抗体)，然后可检测到循环乙型肝炎e抗原(hepatitis B e antigen, HBeAg)。

临床上，1-6个月的前驱期后会出现非特异性症状，包括发热、恶心、呕吐、厌食及腹痛，这些症状的发作通常先于黄疸发作1-14日[2,3]。在这种情况下，尽管肝脏和血液中的病毒滴度可变，但是病毒在肝脏中继续复制且存在持续性病毒血症。

存在亚临床持续性感染、血清氨基转移酶水平正常且肝脏活检结果近乎正常的患者被称为无症状性慢性HBV携带者；而肝功能和组织学特点异常的患者归类为慢性乙型肝炎患者。在前驱期和临床疾病早期，循环中的HBsAg可能较为明显。只有稍迟时候抗-HBsAg才出现，循环病毒产物随后清除。HBV感染相关的关节症状被认为是免疫复合物的形成和沉积所致；已在受累患者中报道了含HBsAg和补体成分的冷沉淀物[4,5]。受累患者可能有更早的抗HBsAg应答，促进免疫复合物的形成[4]。

                        

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Literature review current through: 2017-06 . | This topic last updated: 2016-03-03.
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