Ramos-Casals M, Forns X, Brito-Zerón P, Vargas A, Ruiz M, Laguno M, Yagüe J, Sánchez-Tapias J M, Gatell J M, Font J
Department of Autoimmune Diseases, Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Hospital Clinic, Barcelona, Spain.
J Viral Hepat. 2007 Oct;14(10):736-42. doi: 10.1111/j.1365-2893.2007.00866.x.
To determine whether the clinical and immunological expression of patients with cryoglobulinaemia associated with chronic hepatitis C virus (HCV) infection varied according to HCV-RNA load, HCV genotype or human immunodeficiency virus (HIV) coinfection. We studied 340 HCV patients (188 women and 152 men, with a mean age of 49 years) consecutively diagnosed with cryoglobulinaemia between 1993 and 2003 in our hospital. HCV infection was confirmed by serum HCV-RNA determination in all patients. Two hundred and forty-eight (73%) patients had asymptomatic cryoglobulinaemia and 92 (27%) presented cryoglobulinaemic symptoms. Patients with genotype 1 had a higher mean age at diagnosis of cryoglobulinaemia (48.2 vs 40.2 yrs, P < 0.001) and a higher prevalence of cryoglobulinaemic symptoms (25%vs 10%, P = 0.02), especially of vasculitic features (19%vs 5%, P = 0.014). In comparison with monoinfected HCV patients, those with HIV coinfection had a lower mean age at diagnosis of cryoglobulinaemia (40.4 vs 52.8 years, P < 0.001), a lower prevalence of cryoglobulinaemic symptoms (15%vs 34%, P < 0.001), vasculitis (10%vs 28%, P < 0.001), associated systemic autoimmune disease (3%vs 14%, P = 0.001), rheumatoid factor (30%vs 70%, P = 0.001) and hypocomplementaemia (50%vs 78%, P = 0.01). In HCV-HIV patients, a high viral load was associated with a high frequency of symptomatic cryoglobulinaemia, especially in patients with a high viral load of the two viruses (50%vs 7%, P = 0.001) A higher frequency of cryoglobulinaemic symptoms (especially vasculitis) was found in patients with HCV monoinfection and in those carrying HCV genotype 1. In contrast, patients with HIV coinfection presented a threefold lower prevalence of vasculitis. Associated HIV infection significantly attenuated the clinical and immunological expression of cryoglobulinaemia, except in coinfected patients with high viral loads for the two viruses.
为了确定与慢性丙型肝炎病毒（HCV）感染相关的冷球蛋白血症患者的临床和免疫学表现是否因HCV-RNA载量、HCV基因型或人类免疫缺陷病毒（HIV）合并感染而有所不同。我们研究了1993年至2003年期间在我院连续诊断为冷球蛋白血症的340例HCV患者（188名女性和152名男性，平均年龄49岁）。所有患者均通过血清HCV-RNA测定确诊为HCV感染。248例（73%）患者有无症状冷球蛋白血症，92例（27%）出现冷球蛋白血症症状。1型基因型患者在诊断冷球蛋白血症时的平均年龄较高（48.2岁对40.2岁，P<0.001），冷球蛋白血症症状的患病率较高（25%对10%，P=0.02），尤其是血管炎特征（19%对5%，P=0.014）。与单纯HCV感染患者相比，合并HIV感染的患者在诊断冷球蛋白血症时的平均年龄较低（40.4岁对52.8岁，P<0.001），冷球蛋白血症症状的患病率较低（15%对34%，P<0.001），血管炎（10%对28%，P<0.001）、相关的系统性自身免疫性疾病（3%对14%，P=0.001）、类风湿因子（30%对70%，P=0.001）和低补体血症（50%对78%，P=0.01）。在HCV-HIV患者中，高病毒载量与有症状冷球蛋白血症的高频率相关，尤其是在两种病毒载量都高的患者中（50%对7%，P=0.001）。在HCV单一感染患者和携带HCV 1型基因型的患者中发现冷球蛋白血症症状（尤其是血管炎）的频率较高。相比之下，合并HIV感染的患者血管炎的患病率低三倍。合并HIV感染显著减弱了冷球蛋白血症的临床和免疫学表现，但在两种病毒载量都高的合并感染患者中除外。
