Ignatova T M, Serov V V, Mukhin N A, Kozlovskaia L V, Milovanova S Iu, Aprosina Z G
Klin Med (Mosk). 2005;83(6):37-43.
The authors present literature data and the results of their own studies of mixed cryoglobulinemia (MC) caused by chronic HCV infection, discuss issues concerning pathogenesis of MC as well as MC-associated cryoglobulinemic vasculitis and malignant lymphoproliferation, consider questions of MC influence on the course and prognosis of chronic HCV infection and anti-viral therapy effectiveness. MC was found in 43% of 207 patients with chronic hepatitis type C (CH-C), examined by the researchers. 30% of patients with CH-C and MC displayed clinical signs of vasculitis. The study established the direct correlation between MC severity and the frequency and degree of main clinical manifestations. The results show that more severe clinical variants of cryoglobulinemic glomerulonephritis are associated with MC type II. B-cell lymphoma, monoclonal immunoglobulinopathy and a range of autoimmune syndromes were observed in MC patients. The liver involvement in patients with MC was characterized by a significantly higher sclerosis index compared to the group of patients not having MC while medium liver process activity index was equal in both groups, which suggests possible existence of special mechanisms and faster progress of phibrosis in patients with MC.
作者展示了关于慢性丙型肝炎病毒（HCV）感染所致混合性冷球蛋白血症（MC）的文献数据及他们自己的研究结果，讨论了MC的发病机制以及与MC相关的冷球蛋白血症性血管炎和恶性淋巴增殖性疾病的相关问题，考量了MC对慢性HCV感染病程及预后的影响以及抗病毒治疗效果的问题。研究人员检查的207例丙型慢性肝炎（CH-C）患者中，43%发现有MC。30%的CH-C和MC患者表现出血管炎的临床症状。该研究确立了MC严重程度与主要临床表现的频率和程度之间的直接关联。结果显示，更严重的冷球蛋白血症性肾小球肾炎临床变体与II型MC相关。在MC患者中观察到B细胞淋巴瘤、单克隆免疫球蛋白病及一系列自身免疫综合征。与无MC的患者组相比，MC患者的肝脏受累表现为硬化指数显著更高，而两组的中等肝脏病变活动指数相同，这表明MC患者可能存在特殊机制且纤维化进展更快。
