Lakatos Peter Laszlo, Fekete Sandor, Horanyi Margit, Fischer Simon, Abonyi Margit E
1st Department of Medicine, Semmelweis University, Koranyi str. 2/A, H-1083, Hungary.
World J Gastroenterol. 2006 Apr 14;12(14):2297-300. doi: 10.3748/wjg.v12.i14.2297.
An association between chronic hepatitis C virus (HCV) infection and essential mixed cryoglobulinaemia and non-Hodgkin lymphoma (NHL) has been suggested. However, a causative role of HCV in these conditions has not been established. The authors report a case of a 50 year-old woman with chronic hepatitis C (CHC) who has been followed up since 1998 due to a high viral load, genotype 1b and moderately elevated liver function tests (LFTs). Laboratory data and liver biopsy revealed moderate activity (grade: 5/18, stage: 1/6). In April 1999, one-year interferon therapy was started. HCV-RNA became negative with normalization of LFTs. However, the patient relapsed during treatment. In September 2002, the patient was admitted for chronic back pain. A CT examination demonstrated degenerative changes. In March 2003, multiple myeloma was diagnosed (IgG-kappa, bone ma-rrow biopsy: 50% plasma cell infiltration). MRI revealed a compression fracture of the 5th lumbar vertebral body and an abdominal mass in the right lower quadrant, infiltrating the canalis spinalis. Treatment with vincristine, adriamycin and dexamethasone (VAD) was started and bisphosphonate was administered regularly. In January 2004, after six cycles of VAD therapy, the multiple myeloma regressed. Thalidomide, as a second line treatment of refractory multiple myeloma (MM) was initiated, and followed by peginterferon-alpha2b and ribavirin against the HCV infection in June. In June 2005, LFTs returned to normal, while HCV-RNA was negative, demonstrating an end of treatment response. Although a pathogenic role of HCV infection in malignant lymphoproliferative disorders has not been established, NHL and possibly MM may develop in CHC patients, supporting a role of a complex follow-up in these patients.
慢性丙型肝炎病毒（HCV）感染与原发性混合性冷球蛋白血症及非霍奇金淋巴瘤（NHL）之间的关联已被提出。然而，HCV在这些病症中的致病作用尚未确立。作者报告了一例50岁的慢性丙型肝炎（CHC）女性患者，自1998年起因其高病毒载量、1b型基因型及肝功能检查（LFTs）轻度升高而接受随访。实验室数据和肝活检显示为中度活动（分级：5/18，分期：1/6）。1999年4月，开始为期一年的干扰素治疗。HCV-RNA转为阴性，LFTs恢复正常。然而，患者在治疗期间复发。2002年9月，患者因慢性背痛入院。CT检查显示有退行性改变。2003年3月，诊断为多发性骨髓瘤（IgG-κ型，骨髓活检：50%浆细胞浸润）。MRI显示第五腰椎椎体压缩性骨折及右下腹腹部肿块，侵犯椎管。开始用长春新碱、阿霉素和地塞米松（VAD）治疗，并定期给予双膦酸盐。2004年1月，经过六个周期的VAD治疗后，多发性骨髓瘤病情缓解。开始使用沙利度胺作为难治性多发性骨髓瘤（MM）的二线治疗，随后于6月使用聚乙二醇干扰素-α2b和利巴韦林治疗HCV感染。2005年6月，LFTs恢复正常，HCV-RNA为阴性，表明治疗有反应。尽管HCV感染在恶性淋巴增殖性疾病中的致病作用尚未确立，但CHC患者可能会发生NHL以及可能的MM，这支持了对这些患者进行综合随访的作用。
