La Civita L, Zignego A L, Lombardini F, Monti M, Longombardo G, Pasero G, Ferri C
Istituto di Patologia Medica I, University of Pisa, Italy.
J Rheumatol. 1996 Sep;23(9):1641-3.
An association between hepatotropic viruses, chiefly hepatitis C virus (HCV), occasionally hepatitis B virus (HBV), and mixed cryoglobulinemia has been widely reported. Alpha-interferon (IFN-alpha) has usefully been employed in the treatment of mixed cryoglobulinemia, particularly for liver and renal involvement. IFN-alpha treatment may be associated with neurological complications, including peripheral neuropathy. We describe an HBV positive patient with mixed cryoglobulinemia with recurrent purpura, mild sensory peripheral neuropathy, and active hepatitis treated with IFN-alpha. Rapid improvement of the purpura, liver enzymes, and cryocrit, and disappearance of serum HBV DNA were observed after a 4 week treatment period. However, concomitant worsening of the neuropathy prompted us to discontinue IFN-alpha. Although in this case, a positive effect of IFN-alpha on the clinico-serological and virological variables was confirmed, due to the possible exacerbation of neurological manifestations, a careful patient evaluation is necessary before starting IFN-alpha in patients with mixed cryoglobulinemia.
嗜肝病毒，主要是丙型肝炎病毒（HCV），偶尔还有乙型肝炎病毒（HBV），与混合性冷球蛋白血症之间的关联已被广泛报道。α干扰素（IFN-α）已被有效地用于治疗混合性冷球蛋白血症，特别是对于肝脏和肾脏受累的情况。IFN-α治疗可能与包括周围神经病变在内的神经并发症有关。我们描述了一名HBV阳性的混合性冷球蛋白血症患者，伴有复发性紫癜、轻度感觉性周围神经病变和活动性肝炎，接受了IFN-α治疗。在为期4周的治疗期后，观察到紫癜、肝酶和冷球蛋白血症迅速改善，血清HBV DNA消失。然而，神经病变的同时恶化促使我们停用IFN-α。虽然在这个病例中，证实了IFN-α对临床血清学和病毒学变量有积极作用，但由于可能会加重神经表现，在开始对混合性冷球蛋白血症患者使用IFN-α之前，有必要对患者进行仔细评估。
