冷球蛋白阳性58例临床特征及血清学检测指标分析  

Clinical and laboratory features of 58 patients with positive cryoglobulin

作　　者：温雯[1,2] 李春[1] 贾汝林[1] 栗占国[1] 

机构地区：[1]北京大学人民医院风湿免疫科,风湿病机制及免疫诊断北京市重点实验室,100044 [2]北京清华长庚医院肾内科

出　　处：《中华全科医师杂志》2016年第4期286-290,共5页Chinese Journal of General Practitioners

基　　金：国家自然科学基金青年基金（81202297）

摘　　要：目的探究冷球蛋白阳性患者的疾病诊断、临床及实验室特征，明确冷球蛋白测定在临床诊断中的意义。方法回顾性分析2010年4月至2014年5月北京大学人民医院58例冷球蛋白阳性患者的临床及实验室资料。结果58例冷球蛋白阳性患者中，自身免疫病34例，原发性冷球蛋白血症12例，感染8例，血液病4例。肾脏受累是冷球蛋白血症患者最常见的临床表现（42例，72.4%）。所有患者中，自身免疫病患者临床表现分布最广，所有症状及系统受累表现均有发生；8例HBV、HCV感染患者中7例肾脏受累，其他症状及器官受累少见；4例血液病患者中有3例紫癜，2例肾脏受累，2例关节痛，1例乏力，1例血栓形成，1例出现高黏滞综合征，均无类风湿因子升高。原发性冷球蛋白血症患者多因肾脏受累就诊，患者（5/11）可有抗核抗体（ANA）阳性。结论冷球蛋白血症疾病谱广，临床常见肾脏受累，自身免疫病患者多系统受累更为明显，乙肝、丙肝患者除肾损害外肝外表现少见，血液病患者需警惕高黏滞综合征发生，原发性冷球蛋白血症ANA阳性率高，应注意自身免疫性疾病的筛查及随访。Objective To study the disease spectrum, clinical and lab characteristic of cryoglobulinaemia. Methods The clinical and laboratory data of 58 patients with positive eryoglobulin admitted in Peking University People＇s Hospital from April 2010 to May 2014 were retrospectively analyzed. Results Among 58 patients, 34 were diagnosed as autoimmune disease, 8 as infectious disease, 4 as hematological disease and 12 as primary cryoglobulinemia. Renal involvement was the most frequent clinical presentation among all cryoglobulin positive patients. Patients with autoimmune disease presented all clinical manifestations related to cryoglobulinaemia. Renal involvement （7/8） was prominent in patients with HBV/HCV infection, while other clinical presentations were rare. Among 4 patients with hematological disease, purpura was presented in 3 eases, renal involvement in 2, arthralgia in 2, fatigue, thrombosis or hyperviscosity was presented in 1 case, respectively; however, none of these patients had elevated rheumatoid factor （RF） level. Renal lesions were the most common reason for patients with primary cryoglobulinaemia to consult doctors, and 5 of them had positive antinuclear antibodies （ANA）. Conclusions There is a broad spectrum of disease in cryoglobulinaemia. Multi-system involvement was most common in patients with autoimmune disease. For patients with HBV/HCV infection, extra-hepatic presentations were rare except renal involvement. Hyperviscosity syndrome tended to occur in patients with hematological disease. Since patients with primary eryoglobulinaemia had a relatively high rate of positive antinuclear antibodies, we should keep vigilance at the occurrence of autoimmune disease.

关 键 词：冷球蛋白类 自身免疫疾病 肝炎 病毒性 人 血液病 

分 类 号：R593.2[医药卫生—内科学]