丙型肝炎病毒相关性混合型冷球蛋白血症的治疗进展  

Recent treatment advances for hepatitis C virus-related mixed cryoglobulinemia

作　　者：王宇[1] 张颖[1] 贾战生[1] 

机构地区：[1]第四军医大学唐都医院全军感染病中心,西安710038

出　　处：《临床肝胆病杂志》2012年第8期628-632,共5页Journal of Clinical Hepatology

基　　金：国家自然科学基金项目(81170389);国家"十一五"重大传染病防治专项(2009ZX10004-715)

摘　　要：混合型冷球蛋白血症是一种慢性免疫复合物介导性疾病,与HCV感染密切相关。混合型冷球蛋白血症是一种累及小或中等大小动静脉的血管炎,由抗原、冷球蛋白及补体复合物在血管壁沉积引起。混合型冷球蛋白血症性血管炎主要临床症状包括可触及性紫癜、关节痛及乏力三联征,以及其他病理表现,如肾小球肾炎、周围神经病变、皮肤溃疡等。由于临床表现多样、病情轻重不等,使得HCV相关性混合型冷球蛋白血症的治疗极其困难。目前主要的治疗方法包括抗HCV感染治疗、抑制B细胞克隆性增殖和冷球蛋白产生以及对症治疗等。此外,最恰当的治疗策略的选择必须依据疾病的活动情况及脏器损害严重程度的评估,为此本文作一综述,希望对HCV相关性混合型冷球蛋白血症临床治疗提供参考。Mixed cryoglobulinemia is a chronic immune complex - mediated disease that is closely associated with hepatitis C virus （ HCV ） infection. The vasculitis effect of this disease, involving small or middle - sized arteries and veins, manifests upon sedimentation of comple- xes of antigen, cryoglobulin, and complement in the vessel walls. The main clinical symptoms of mixed cryoglobulin vasculitis include a triad of palpable purpura, arthralgias and weakness. Other pathological signs include glomerulonephritis, peripheral neuropathy, skin ulcers, and widespread vasculitis. Heterogeneous presentation complicates treatment strategies, especially for patients with underlying HCV infection. The current treatment strategies for HCV - related mixed cryoglobulinemia are discussed in this review, including anti - HCV therapies, inhi- bition of B cell clonal proliferation, and inhibition of cryoglobulin production. In addition, the palliative treatments used to improve the relat- ed symptoms and signs are touched upon. While many treatment options exist, the most appropriate treatment strategy must be selected on an individual patient basis by analysis of disease activity and severity of organ damage.

关 键 词：冷球蛋白血症 肝炎病毒属 感染 

分 类 号：R512.63[医药卫生—内科学]