Levey J M, Bjornsson B, Banner B, Kuhns M, Malhotra R, Whitman N, Romain P L, Cropley T G, Bonkovsky H L
Department of Medicine, University of Massachusetts Medical Center, Worcester 01655.
Medicine (Baltimore). 1994 Jan;73(1):53-67. doi: 10.1097/00005792-199401000-00005.
We present 10 cases of mixed cryoglobulinemia in patients infected with hepatitis C, including pertinent clinical, serologic, and pathological data. The findings attributable to MC appear to be similar in patients who are HCV-infected as in those with unknown HCV status. The prevalence of MC in HCV-infected patients appears to be lower in our region (13%) than in southern Europe (50-90%) although some of this difference is due to our requirement that patients included in our study have a cryocrit of at least 5%. In our patients, cryoglobulins were shown to be deposited in skin and kidney, but not in liver. The mechanisms by which HCV and MC are related remain uncertain. Although we and others have evidence for enrichment of HCV RNA in the cryoprecipitates of some patients, this was not always the case, and it is not yet clear that this finding is of fundamental pathogenic importance. Finally, it appears that some patients with HCV and MC may have a beneficial clinical response of vasculitic symptoms to therapy with alpha-interferon, as well as to glucocorticoids or other immunosuppressants. In our group, no predictors were apparent to distinguish responders from nonresponders before treatment. Similarly, the duration of response remains to be determined.
我们报告了10例丙型肝炎感染患者的混合性冷球蛋白血症病例，包括相关的临床、血清学和病理学数据。丙型肝炎病毒（HCV）感染患者中归因于混合性冷球蛋白血症（MC）的表现似乎与HCV感染状态不明的患者相似。在我们地区，HCV感染患者中MC的患病率（13%）似乎低于南欧（50 - 90%），不过这种差异部分归因于我们要求纳入研究的患者冷球蛋白比容至少为5%。在我们的患者中，冷球蛋白显示沉积于皮肤和肾脏，但未沉积于肝脏。HCV与MC相关的机制仍不确定。尽管我们和其他人有证据表明在一些患者的冷沉淀物中HCV RNA富集，但情况并非总是如此，而且这一发现是否具有根本的致病重要性尚不清楚。最后，似乎一些HCV和MC患者的血管炎症状对α干扰素治疗以及糖皮质激素或其他免疫抑制剂可能有良好的临床反应。在我们的研究组中，治疗前没有明显的预测指标可区分反应者和无反应者。同样，反应持续时间仍有待确定。
