Mazzaro C, Pozzato G, Moretti M, Crovatto M, Modolo M L, Mazzi G, Santini G
Department of Medicine, Pordenone General Hospital, Italy.
Haematologica. 1994 Jul-Aug;79(4):342-9.
Several reports showed that mixed cryoglobulinemia (MC) is closely associated with hepatitis C virus (HCV) infection. Since several authors reported the efficacy of alpha-interferon in the treatment of MC, we investigated the long-term effects of this drug on clinical, hematological and virological parameters in a group of 18 patients (13 women and 5 men, mean age 56 +/- 11 years) affected by MC.
A bone marrow biopsy was performed in all patients, and a liver biopsy was obtained in those with biochemical signs of chronic liver disease. The presence of HCV-RNA in serum was assessed by detection of anti-HCV antibodies and by PCR amplification of the 5' untranslated region of HCV. All patients followed the same treatment schedule: three million units of recombinant interferon alpha-2b s.c., three times a week for 1 year.
In 5 cases bone marrow histology showed the presence of a monoclonal lymphocytic infiltrate. Liver biopsies were performed in 13 (72%) of the patients and a chronic liver disease was found in all 13. Anti-HCV antibodies were present in 17 (95%) subjects. HCV-RNA was detected in all cases (100%) before therapy. Five (28%) patients achieved a complete response and 9 (50%) a partial response, while the others (4 cases, 22%) showed minor responses. Four patients cleared the virus and obtained a complete remission of the MC.
HCV may be a cause of MC. The disease is associated with a high incidence of monoclonal lymphocytic infiltrate of the bone marrow. Alpha-interferon seems to be an effective agent for the treatment of MC.
多项报告显示，混合性冷球蛋白血症（MC）与丙型肝炎病毒（HCV）感染密切相关。由于多位作者报道了α干扰素治疗MC的疗效，我们对一组18例受MC影响的患者（13名女性和5名男性，平均年龄56±11岁）进行了该药物对临床、血液学和病毒学参数的长期影响研究。
对所有患者进行骨髓活检，对有慢性肝病生化指标的患者进行肝活检。通过检测抗HCV抗体和对HCV 5'非翻译区进行PCR扩增来评估血清中HCV-RNA的存在。所有患者遵循相同的治疗方案：皮下注射重组干扰素α-2b 300万单位，每周3次，共1年。
5例骨髓组织学显示存在单克隆淋巴细胞浸润。13例（72%）患者进行了肝活检，所有13例均发现有慢性肝病。17例（95%）受试者存在抗HCV抗体。治疗前所有病例（100%）均检测到HCV-RNA。5例（28%）患者达到完全缓解，9例（50%）部分缓解，其余4例（22%）显示轻度缓解。4例患者病毒清除，MC完全缓解。
HCV可能是MC的病因。该疾病与骨髓单克隆淋巴细胞浸润的高发生率相关。α干扰素似乎是治疗MC的有效药物。
