Yumura W, Miwa N, Watanabe Y, Ozaki N, Naito T, Ozu H, Nitta K, Hara Y, Nihei H
Department of Medicine, Tokyo Women's Medical College, Japan.
Nihon Jinzo Gakkai Shi. 1995 Oct;37(10):587-94.
We report here two cases of mixed cryoglobulinemia showing renal involvement associated with hepatitis C virus (HCV) infection. The subjects were 62- and 63-year-old males. Both patients presented with purpura on the legs, which was diagnosed as allergic vasculitis by skin biopsy. Case 1 followed a clinical course of progressive nephrotic syndrome with mild hematuria. He also had diabetes mellitus and hypertension. In contrast, case 2 showed only mild hematuria without proteinuria at the time of the renal biopsy. Both cases had immunological disarrangements, such as severe hypocomplimentemia and seropositive rheumatic factor. Recently, it was reported that patients with type II mixed cryoglobulinemia had HCV seropositivity, and revealed membranoproliferative glomerulonephritis. These facts strongly suggested that renal lesions are the result of direct damage mediated by cryoglobulinemia and an activated complement pathway through an immune complex mechanism related to HCV.
我们在此报告两例混合性冷球蛋白血症病例，其显示出与丙型肝炎病毒（HCV）感染相关的肾脏受累。患者为62岁和63岁男性。两名患者均出现腿部紫癜，经皮肤活检诊断为过敏性血管炎。病例1呈现为进展性肾病综合征伴轻度血尿的临床病程。他还患有糖尿病和高血压。相比之下，病例2在肾活检时仅显示轻度血尿而无蛋白尿。两例均有免疫紊乱，如严重补体低下和风湿因子血清学阳性。最近有报道称，II型混合性冷球蛋白血症患者HCV血清学呈阳性，并显示膜增生性肾小球肾炎。这些事实强烈提示，肾脏病变是由冷球蛋白血症介导的直接损伤以及通过与HCV相关的免疫复合物机制激活补体途径的结果。
