Apartis E, Léger J M, Musset L, Gugenheim M, Cacoub P, Lyon-Caen O, Pierrot-Deseilligny C, Hauw J J, Bouche P
Department of Neurology, Hôpital Pitié-Salpêtrière, Paris, France.
J Neurol Neurosurg Psychiatry. 1996 Jun;60(6):661-6. doi: 10.1136/jnnp.60.6.661.
The prevalence of hepatitis C virus (HCV) infection has been estimated at 43 to 84% in patients with essential mixed cryoglobulinaemia in recent large series. Some of these cases have been successfully treated with interferon-alpha. The objective was to evaluate the prevalence and the possible role of HCV infection in essential mixed cryoglobulinaemia.
Fifteen patients (eight men and seven women; mean age: 61.2 (SD 16.5) years) with peripheral neuropathy (10 polyneuropathies and five multifocal mononeuropathies) and essential mixed cryoglobulinaemia were tested for serum anti-HCV antibodies.
Antibodies were found in 10 of 15 patients involving either polyneuropathies (seven patients) or multifocal mononeuropathies (three patients). Electrophysiological studies and teased nerve fibre studies (in seven patients) allowed neuropathies to be classified as predominantly sensory axonopathies. Compared with HCV-negative (HCV -) patients, HCV-positive (HCV +) patients had a more pronounced and more widespread motor deficit; motor nerve conduction velocities in peroneal and median nerves were more impaired in HCV + patients, although significance was not reached except for the mean value of the amplitude of the compound muscle action potentials of the median nerves (P < 0.05); necrotising vasculitis was found in two of nine nerve biopsies from the HCV + patients studied and in none of the three HCV - patients. In addition, HCV + patients had more frequent cryoglobulin related cutaneous signs, higher aminotransferase and serum cryoglobulin concentrations, lower total haemolytic complement concentrations, and more frequent presence of rheumatoid factor. A liver biopsy performed in eight HCV + patients disclosed a range of lesions, from chronic active hepatitis (six patients) to persistent hepatitis (two patients). Lastly, treatment with interferon-alpha conducted over six months in two patients seemed to improve the peripheral neuropathy.
Patients with peripheral neuropathy and essential mixed cryoglobulinaemia should be tested for anti-HCV antibodies to determine the appropriate treatment.
在近期的大型研究系列中，估计原发性混合性冷球蛋白血症患者丙型肝炎病毒（HCV）感染率为43%至84%。其中一些病例已成功接受α干扰素治疗。目的是评估HCV感染在原发性混合性冷球蛋白血症中的患病率及可能作用。
对15例患有周围神经病变（10例多发性神经病和5例多灶性单神经病）和原发性混合性冷球蛋白血症的患者（8例男性和7例女性；平均年龄：61.2（标准差16.5）岁）检测血清抗HCV抗体。
15例患者中有10例检测到抗体，其中包括多发性神经病患者（7例）或多灶性单神经病患者（3例）。电生理研究和神经束纤维研究（7例患者）显示神经病变主要为感觉轴索性神经病。与HCV阴性（HCV -）患者相比，HCV阳性（HCV +）患者运动功能障碍更明显且更广泛；HCV +患者腓总神经和正中神经的运动神经传导速度受损更严重，尽管除正中神经复合肌肉动作电位波幅平均值外未达到统计学意义（P < 0.05）；在研究的HCV +患者的9例神经活检中有2例发现坏死性血管炎，而3例HCV -患者均未发现。此外，HCV +患者冷球蛋白相关皮肤体征更常见，转氨酶和血清冷球蛋白浓度更高，总溶血补体浓度更低，类风湿因子阳性更频繁。对8例HCV +患者进行的肝活检显示一系列病变，从慢性活动性肝炎（6例患者）到持续性肝炎（2例患者）。最后，2例患者接受6个月的α干扰素治疗似乎改善了周围神经病变。
患有周围神经病变和原发性混合性冷球蛋白血症的患者应检测抗HCV抗体以确定合适的治疗方法。
