Ramunni A, Lauletta G, Brescia P, Saliani M T, Montrone M, Chironna M, Sansonno D, Dammacco F, Coratelli P
Section of Nephrology, Department of Internal and Public Medicine, University of Bari, Bari, Italy.
J Clin Apher. 2008;23(3):118-22. doi: 10.1002/jca.20166.
Hepatitis C virus (HCV) is the major cause of cryoglobulinemia. Skin lesions are frequent and can be cured from the removal of cryoglobulins by therapeutic apheresis. We describe a case of HCV-positive type I cryoglobulinemia with severe leg ulcers, not responsive to antiviral and immunosuppressive treatment. Thirty sessions of double filtration plasmapheresis were performed, over a period of 6 months, with no other associated treatment. Before and after each session an assessment of immunoglobulins, complement, cryocrit, and fibrinogen was made. HCV RNA levels were determined in serum cryoprecipitate, supernatant before and after each session, and in the collection bag. No differences in pre and postapheresis values were observed in the serum concentrations and the supernatant, whereas the postapheresis cryoprecipitate showed a significantly reduced viral load (P < 0.02) as compared with the preapheresis values. There was improvement in the condition of ulcers in the leg during apheresis and had completely regressed by the end of the cycle.
丙型肝炎病毒（HCV）是冷球蛋白血症的主要病因。皮肤病变很常见，通过治疗性血液成分单采去除冷球蛋白后可治愈。我们描述了一例HCV阳性的I型冷球蛋白血症患者，其患有严重的腿部溃疡，对抗病毒和免疫抑制治疗无反应。在6个月的时间里进行了30次双重过滤血浆置换，未进行其他相关治疗。每次治疗前后均对免疫球蛋白、补体、冷沉淀比容和纤维蛋白原进行评估。在血清冷沉淀物、每次治疗前后的上清液以及收集袋中测定HCV RNA水平。在血清浓度和上清液中，血液成分单采前后的值未观察到差异，而血液成分单采后的冷沉淀物与血液成分单采前的值相比，病毒载量显著降低（P < 0.02）。在血液成分单采期间，腿部溃疡状况有所改善，在疗程结束时已完全消退。
