Willson R A
Department of Medicine, University of Washington, Seattle, Washington, USA.
J Clin Gastroenterol. 2001 Aug;33(2):137-40. doi: 10.1097/00004836-200108000-00009.
The efficacy of long-term interferon therapy for chronic hepatitis C infection with symptomatic mixed cryoglobulinemia has not clearly been defined. We describe a patient with chronic hepatitis C, symptomatic mixed cryoglobulinemia (cutaneous vasculitis), and membranoproliferative glomerulonephritis (MPGN) who responded clinically, biochemically, and virologically to a 1-year course of interferon therapy. Interferon side effects were minimal. Relapse occurred when interferon was discontinued, and suppressive maintenance interferon therapy was required for clinical, biochemical, and virologic remission. During the 5th year of maintenance therapy, she developed potential side effects that necessitated discontinuation of interferon treatment. After treatment stoppage, a clinical, biochemical, and virologic remission was maintained for more than 1 year. However, the potential side effects, which included eye irritation, arthralgias, myalgias, fatigue, insomnia, memory loss, and depression, persisted. Ophthalmologic, rheumatologic, and neurologic evaluations were nondiagnostic. Psychometric testing revealed dementia and mood disorder. Because the disabling symptoms persisted after 9 months, a health-related quality of life assessment was carried out with the SF-36 survey. Compared with healthy individuals and patients with chronic hepatitis C, our case had a lower health-related quality of life assessment on six out of seven scales and on four out of seven scales of the SF-36 survey, respectively. This case report indicates that long-term maintenance interferon therapy was effective in the treatment of symptomatic mixed cryoglobulinemia and its renal complications and resulted in a clinical, biochemical, and virologic sustained response. It is postulated that the side effects of long-term interferon therapy in this setting may be problematic.
长期干扰素治疗对伴有症状性混合性冷球蛋白血症的慢性丙型肝炎感染的疗效尚未明确界定。我们描述了一名患有慢性丙型肝炎、症状性混合性冷球蛋白血症（皮肤血管炎）和膜增生性肾小球肾炎（MPGN）的患者，该患者在接受为期1年的干扰素治疗后，在临床、生化和病毒学方面均有反应。干扰素的副作用极小。停用干扰素后病情复发，需要进行抑制性维持干扰素治疗以实现临床、生化和病毒学缓解。在维持治疗的第5年，她出现了可能需要停用干扰素治疗的副作用。停药后，临床、生化和病毒学缓解维持了1年多。然而，包括眼部刺激、关节痛、肌痛、疲劳、失眠、记忆力减退和抑郁在内的潜在副作用仍然存在。眼科、风湿科和神经科评估均未明确诊断。心理测试显示存在痴呆和情绪障碍。由于致残症状在9个月后仍持续存在，因此使用SF - 36调查问卷进行了与健康相关的生活质量评估。与健康个体和慢性丙型肝炎患者相比，我们的病例在SF - 36调查问卷的七个量表中的六个量表以及七个量表中的四个量表上，与健康相关的生活质量评估得分较低。本病例报告表明，长期维持干扰素治疗对症状性混合性冷球蛋白血症及其肾脏并发症有效，并导致了临床、生化和病毒学的持续反应。据推测，在这种情况下长期干扰素治疗的副作用可能是个问题。
