Akriviadis E A, Xanthakis I, Navrozidou C, Papadopoulos A
University of Southern California Liver Unit, Downey, USA.
J Clin Gastroenterol. 1997 Dec;25(4):612-8. doi: 10.1097/00004836-199712000-00013.
Chronic hepatitis C virus (HCV) infection is associated with a variety of clinically important extrahepatic abnormalities. We have assessed the prevalence of cryoglobulinemia and of the clinical syndrome associated with it in patients with chronic HCV infection. We also have evaluated the clinical, serologic, and biochemical response to antiviral treatment with interferon-alpha (IFN-alpha). Eighty-one patients with chronic liver disease associated with HCV infection were included. Cryoglobulins were sought in the serum. All patients were examined carefully for clinical manifestations of cryoglobulinemia (e.g., palpable purpura, Raynaud's syndrome, arthritis, peripheral neuropathy, Sjögren's syndrome, glomerulonephritis). Antiviral treatment with IFN-alpha, at a dose of 3 to 5 million units, 3 times weekly, was given to 20 patients with cryoglobulinemia. Cryoglobulins were detected in 45.7% of patients. Signs and symptoms of the clinical syndrome associated with cryoglobulinemia were present in 12.3% of the entire group of patients (27% of the subgroup with detectable cryoglobulins). Patients with cryoglobulinemia were older (mean age, 56 +/- 15 vs. 44 +/- 16 years; p = 0.002) and had a higher rate of cirrhosis (48.6% vs. 18.2%, rate ratio = 4.26, 95% confidence interval = 2.11 to 8.58, p = 0.00005) compared to patients without cryoglobulinemia. Cryoglobulins disappeared from the serum in 13 (65%) of the 20 patients who were treated for 6 to 12 months with IFN-alpha. This effect was affiliated in most patients with resolution of the clinical findings associated with cryoglobulinemia and return of transaminases to normal levels. Recurrence of cryoglobulinemia was observed in two thirds of the patients who were observed after treatment with IFN-alpha. We conclude that cryoglobulins are present in 45.7% of patients with chronic HCV infection. Symptoms or signs or both associated with the presence of cryoglobulins develop in a high proportion (27%) of these patients. Antiviral treatment with IFN-alpha leads to resolution of both cryoglobulinemia and the symptoms associated with it in most patients who also show a biochemical response to antiviral treatment. Recurrence is frequent after treatment withdrawal.
慢性丙型肝炎病毒（HCV）感染与多种临床上重要的肝外异常有关。我们评估了慢性HCV感染患者中冷球蛋白血症及其相关临床综合征的患病率。我们还评估了抗病毒治疗用α干扰素（IFN-α）后的临床、血清学和生化反应。纳入了81例与HCV感染相关的慢性肝病患者。检测血清中的冷球蛋白。仔细检查所有患者有无冷球蛋白血症的临床表现（如可触及的紫癜、雷诺综合征、关节炎、周围神经病变、干燥综合征、肾小球肾炎）。20例冷球蛋白血症患者接受了剂量为300万至500万单位、每周3次的α干扰素抗病毒治疗。45.7%的患者检测到冷球蛋白。整个患者组中12.3%（冷球蛋白可检测到的亚组中的27%）出现了与冷球蛋白血症相关的临床综合征的体征和症状。与无冷球蛋白血症的患者相比，冷球蛋白血症患者年龄更大（平均年龄，56±15岁对44±16岁；p = 0.002），肝硬化发生率更高（48.6%对18.2%，率比 = 4.26，95%置信区间 = 2.11至8.58，p = 0.00005）。20例接受α干扰素治疗6至12个月的患者中，13例（65%）血清冷球蛋白消失。这种效应在大多数患者中与冷球蛋白血症相关的临床症状消失以及转氨酶恢复正常水平有关。α干扰素治疗后观察的患者中有三分之二出现冷球蛋白血症复发。我们得出结论，45.7%的慢性HCV感染患者存在冷球蛋白。这些患者中很大比例（27%）出现与冷球蛋白存在相关的症状或体征或两者皆有。在大多数对抗病毒治疗有生化反应的患者中，α干扰素抗病毒治疗可使冷球蛋白血症及其相关症状得到缓解。停药后复发很常见。
