Mazzaro C, Pozzato G, Zorat F, Panarello G, Silvestri F, Barillari G, Mazzoran L, Baracetti S, Crovatto M, Santini G F, Donadon V, Faccini L, Campanacci L
Third Department of Medicine, University of Trieste, School of Medicine, Italy.
Ital J Gastroenterol Hepatol. 1999 Jan-Feb;31(1):45-53.
BACKGROUND/AIM: A striking correlation between mixed cryoglobulinaemia and chronic hepatitis C virus infection has recently been described. Since membrano-proliferative glomerulonephritis is a rare complication of mixed cryoglobulinaemia, this study was undertaken to determine the prevalence of Hepatitis C virus infection in membrano-proliferative glomerulonephritis.
Eighteen patients, selected among a group of 121 affected by mixed cryoglobulinaemia, with renal involvement were included in the present study. A group of 148 patients affected by renal disease of different aetiology and the general population (6,917 people) were used as control groups.
The presence of anti-hepatitis C virus antibodies was determined by a commercial kit. The hepatitis C virus genotype was determined according to Okamoto. All patients underwent kidney and bone marrow biopsy, while the hepatic biopsy was performed in those showing signs of chronic liver disease.
In patients with renal involvement, the kidney biopsy showed the presence of membrano-proliferative glomerulonephritis Type I in all cases. Chronic liver disease was present in eleven patients (61%). All patients were positive for serum hepatitis C virus-RNA. Bone marrow biopsy was normal in five cases, while in the others paratrabecular foci of infiltration by small lymphocytes were present. In six of these, the massive bone marrow infiltration by lymphoplas-macytoid lymphocytes suggested the diagnosis of low grade non-Hodgkin's lymphoma. In the group of patients affected by other chronic renal disease, the prevalence of hepatitis C virus infection (3.1%) was not different from that of the general population (3.2%).
Hepatitis C virus seems to be the aetiologic agent of mixed cryoglobulinaemia and, consequently, of membrano-proliferative glomerulonephritis.
背景/目的：近期研究表明混合性冷球蛋白血症与慢性丙型肝炎病毒感染之间存在显著相关性。由于膜增生性肾小球肾炎是混合性冷球蛋白血症的一种罕见并发症，本研究旨在确定膜增生性肾小球肾炎中丙型肝炎病毒感染的患病率。
本研究纳入了121例混合性冷球蛋白血症患者中选取的18例有肾脏受累的患者。选取148例病因不同的肾病患者及普通人群（6917人）作为对照组。
使用商用试剂盒检测抗丙型肝炎病毒抗体的存在情况。根据冈本方法确定丙型肝炎病毒基因型。所有患者均接受肾脏和骨髓活检，有慢性肝病迹象的患者进行肝脏活检。
在有肾脏受累的患者中，肾脏活检显示所有病例均为I型膜增生性肾小球肾炎。11例患者（61%）存在慢性肝病。所有患者血清丙型肝炎病毒RNA均为阳性。5例患者骨髓活检正常，其他患者存在小淋巴细胞小梁旁浸润灶。其中6例患者骨髓被淋巴浆细胞样淋巴细胞大量浸润，提示为低度非霍奇金淋巴瘤。在其他慢性肾病患者组中，丙型肝炎病毒感染的患病率（3.1%）与普通人群（3.2%）无差异。
丙型肝炎病毒似乎是混合性冷球蛋白血症以及由此导致的膜增生性肾小球肾炎的病因。
