Sene Damien, Ghillani-Dalbin Pascale, Thibault Vincent, Guis Laurence, Musset Lucile, Duhaut Pierre, Poynard Thierry, Piette Jean-Charles, Cacoub Patrice
Department of Internal Medicine, Hôpital La Pitié-Salpêtrière, Paris, France.
J Rheumatol. 2004 Nov;31(11):2199-206.
To describe epidemiological, clinical, and immunological characteristics and the longterm course of persistent mixed cryoglobulinemia (MC) in patients infected with hepatitis C virus (HCV).
Retrospective study of HCV infected patients (HCV RNA positive) who had persistent positive MC, with 2 immunochemical typings of MC carried out after 24-month minimum interval.
In total, 125 patients were studied, aged 52 +/- 13 years at diagnosis of MC, with duration of HCV infection of 18 +/- 10 years. At entry, 60 patients had type II MC, 53 patients had type III, and 12 patients had the oligoclonal type. At the second immunochemical typing, after a mean interval of 45 +/- 20 months, MC was type II in 72 patients, type III in 39 patients, and the oligoclonal type in 14 patients. The proportion of cases of MC with the same immunochemical type was higher among patients with type II (78%) than type III (59%) or oligoclonal MC (17%) (p < 0.01). The MC that changed turned more to type II (55.5%) than type III (29%) or the oligoclonal type (15.5%) (p = 0.0002). MC vasculitis (purpura, arthralgia, peripheral neuropathy, renal involvement) and other extrahepatic manifestations (polyarteritis nodosa, lymphoma) in 60/125 patients was associated with advanced age (p < 0.01), a longer duration of infection (p < 0.05), type II MC (odds ratio = 5, p < 0.01), and a higher MC serum level (p < 0.01).
During chronic active HCV infection, type II MC is more stable over time than type III and oligoclonal MC. The oligoclonal type appears to be an intermediate stage in the course of type III changing to type II MC. Symptomatic persistent HCV MC was associated with advanced age, longer duration of HCV infection, type II MC, and a higher MC serum level.
描述丙型肝炎病毒（HCV）感染患者持续性混合性冷球蛋白血症（MC）的流行病学、临床和免疫学特征以及长期病程。
对HCV感染患者（HCV RNA阳性）进行回顾性研究，这些患者MC持续呈阳性，至少间隔24个月进行2次MC免疫化学分型。
共研究了125例患者，诊断MC时年龄为52±13岁，HCV感染持续时间为18±10年。初诊时，60例患者为II型MC，53例为III型，12例为寡克隆型。在平均间隔45±20个月后的第二次免疫化学分型中，72例患者为II型MC，39例为III型，14例为寡克隆型。II型患者中免疫化学分型相同的MC病例比例（78%）高于III型（59%）或寡克隆型MC（17%）（p<0.01）。发生变化的MC转变为II型（55.5%）的比例高于III型（29%）或寡克隆型（15.5%）（p=0.0002）。125例患者中有60例出现MC血管炎（紫癜、关节痛、周围神经病变、肾脏受累）和其他肝外表现（结节性多动脉炎、淋巴瘤），这些与高龄（p<0.01）、感染持续时间较长（p<0.05）、II型MC（优势比=5，p<0.01）以及较高的MC血清水平（p<0.01）相关。
在慢性活动性HCV感染期间，II型MC随时间推移比III型和寡克隆型MC更稳定。寡克隆型似乎是III型转变为II型MC过程中的一个中间阶段。有症状的持续性HCV MC与高龄、HCV感染持续时间较长、II型MC以及较高的MC血清水平相关。
