Joshi Supriya, Kuczynski Magdalena, Heathcote E Jenny
Department of Medicine, Toronto Western Hospital, University Health Network, 399 Bathurst Street, Toronto, Ontario M5T 2S8, USA.
Dig Dis Sci. 2007 Sep;52(9):2410-7. doi: 10.1007/s10620-006-9355-2. Epub 2007 Apr 6.
Mixed cryoglobulins are detected in 50% of patients with hepatitis C; fortunately, few have vasculitis affecting skin, peripheral nerves, kidneys, and synovia. This study was designed to identify the natural history of symptomatic cryoglobulinemia and evaluate the response to antiviral therapy. Patients with hepatitis C complicated by symptomatic cryoglobulinemia were assessed for their disease manifestations and response to antiviral therapy. Of 83 patients identified, 56 patients with a minimum of 12 months follow-up were reviewed. Manifestations included dermatologic (75%), rheumatologic (57%), neurologic (34%), and renal (proteinuria 25%). Antiviral therapy was given to 38, of whom 9 were retreated for symptomatic and/or virological nonresponse. Antiviral therapy included interferon monotherapy (n= 8), pegylated-interferon monotherapy (n= 5), consensus-interferon (n= 2), interferon + ribavirin (n= 18), and pegylated-interferon + ribavirin (n= 14). Treatment provided sustained symptomatic response in 31 (82%) and virological response in 16 (42%) patients. Symptomatic cryoglobulinemia responds well to antiviral therapy, even when virological response is not achieved.
50%的丙型肝炎患者可检测到混合性冷球蛋白血症；幸运的是，很少有人出现影响皮肤、周围神经、肾脏和滑膜的血管炎。本研究旨在确定有症状性冷球蛋白血症的自然病程，并评估对抗病毒治疗的反应。对丙型肝炎合并有症状性冷球蛋白血症的患者进行疾病表现及对抗病毒治疗反应的评估。在确定的83例患者中，对56例至少随访12个月的患者进行了回顾。表现包括皮肤（75%）、风湿（57%）、神经（34%）和肾脏（蛋白尿25%）方面的症状。38例患者接受了抗病毒治疗，其中9例因症状性和/或病毒学无反应而再次治疗。抗病毒治疗包括干扰素单药治疗（n = 8）、聚乙二醇化干扰素单药治疗（n = 5）、共识干扰素（n = 2）、干扰素+利巴韦林（n = 18）和聚乙二醇化干扰素+利巴韦林（n = 14）。治疗使31例（82%）患者获得持续症状缓解，16例（42%）患者获得病毒学缓解。即使未实现病毒学缓解，有症状性冷球蛋白血症对抗病毒治疗反应良好。
