Alric Laurent, Plaisier Emmanuelle, Thébault Sophie, Péron Jean-Marie, Rostaing Lionel, Pourrat Jacques, Ronco Pierre, Piette Jean-Charles, Cacoub Patrice
Service de Médecine Interne, Pavillon Dieulafoy, CHU Purpan, Toulouse, France.
Am J Kidney Dis. 2004 Apr;43(4):617-23. doi: 10.1053/j.ajkd.2003.11.020.
The influence of hepatitis C virus (HCV) treatment on the course of HCV cryoglobulinemic membranoproliferative glomerulonephritis (MPGN) is controversial.
Twenty-five patients with nephrotic-range proteinuria, mixed cryoglobulinemia, MPGN proved by renal biopsy, and HCV infection were studied for their response to antiviral treatment.
After first-line treatment with prednisone, furosemide, or plasmapheresis, antiviral therapy with standard or pegylated interferon alfa and ribavirin was introduced in 18 patients. These patients were compared with 7 patients who did not receive antiviral treatment. Mean duration of antiviral treatment was 18 +/- 10 months, with a follow-up of at least 6 months after treatment withdrawal. HCV RNA clearance (sustained virological response) was achieved in 12 of 18 patients. Compared with values before antiviral therapy, a decrease in proteinuria was observed in sustained virological responders at the end of combination therapy, as well as at the end of follow-up (mean, 2.85 +/- 2.2 [SD] versus 1 +/- 1.4 and 0.4 +/- 0.8 g/d, respectively; P < 0.05). In sustained virological responders, cryoglobulin levels at the end of treatment (0.29 +/- 0.4 g/L) and end of follow-up (0.25 +/- 0.4 g/L) were decreased (P < 0.05) compared with pretreatment values (1.38 +/- 2.2 g/L). Conversely, no changes in serum cryoglobulinemia levels were observed in nonresponders or controls. Serum creatinine levels remained stable in the 18 patients with antiviral therapy, regardless of response to treatment.
Anti-HCV treatment improved HCV-associated cryoglobulinemic glomerulonephritis.
丙型肝炎病毒（HCV）治疗对HCV冷球蛋白血症性膜增生性肾小球肾炎（MPGN）病程的影响存在争议。
对25例患有肾病范围蛋白尿、混合性冷球蛋白血症、经肾活检证实为MPGN且感染HCV的患者进行抗病毒治疗反应的研究。
在先用泼尼松、呋塞米或血浆置换进行一线治疗后，18例患者开始使用标准或聚乙二醇化干扰素α和利巴韦林进行抗病毒治疗。将这些患者与7例未接受抗病毒治疗的患者进行比较。抗病毒治疗的平均持续时间为18±10个月，停药后至少随访6个月。18例患者中有12例实现了HCV RNA清除（持续病毒学应答）。与抗病毒治疗前的值相比，持续病毒学应答者在联合治疗结束时以及随访结束时蛋白尿均有所减少（分别为平均2.85±2.2[标准差]与1±1.4和0.4±0.8g/d；P<0.05）。在持续病毒学应答者中，治疗结束时（0.29±0.4g/L）和随访结束时（0.25±0.4g/L）的冷球蛋白水平与治疗前值（1.38±2.2g/L）相比有所降低（P<0.05）。相反，无应答者或对照组的血清冷球蛋白血症水平未见变化。在接受抗病毒治疗的18例患者中，无论治疗反应如何，血清肌酐水平均保持稳定。
抗HCV治疗改善了HCV相关的冷球蛋白血症性肾小球肾炎。
