丙型肝炎病毒相关性混合型冷球蛋白血症的治疗进展

王宇; 张颖; 贾战生

丙型肝炎病毒相关性混合型冷球蛋白血症的治疗进展

第四军医大学唐都医院全军感染病中心

基金项目:

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)；

详细信息

中图分类号: R512.63
计量
- 文章访问数: 247
- HTML全文浏览量: 14
- PDF下载量: 287
- 被引次数: 0
出版历程
- 出版日期: 2012-08-20

Recent treatment advances for hepatitis C virus-related mixed cryoglobulinemia

Research funding:

摘要

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。
- 冷球蛋白血症 /
- 肝炎病毒属 /
- 感染
Abstract: 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 complexes 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, inhibition of B cell clonal proliferation, and inhibition of cryoglobulin production.In addition, the palliative treatments used to improve the related 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.
- cryoglobulinmia /
- hepacivirus /
- infection

HTML全文

参考文献(45)

[1] Jacobson IM, Cacoub P, Dal Maso L, et al. Manifestations of chronic hepatitis C virus infection beyond the liver[J]. Clin Gastroenterol Hepatol, 2010, 8 (12) : 1017-1029.

[2]Ramos-Casals M, Stone JH, Cid MC, et al.The cryoglobu-linaemias[J].Lancet, 2012, 379 (9813) :348-360.

[3]St Clair EW.Hepatitis C virus-related cryoglobulinemic vas-culitis:emerging trends intherapy[J].Arthritis Rheum, 2012, 64 (3) :604-608.

[4]Nicolau A, T n sescu R, B l nescu E, et al.Hepatitis C vi-rus-mixed cryoglobulinemia-lymphoma relationship[J].Rom J Intern Med, 2011, 49 (1) :3-10.

[5]Disdier P, Harle JR, Weiller PJ.Cryoglobulinemia and hepa-titis C virus infection[J].Lancet, 1991, 338 (8775) :1151-1152.

[6] Agnello V, Chung RT, Kaplan LM. A role for hepatitis C virus infection in type II cryoglobulinemia[J]. N Engl J Med, 1992, 327 (21) : 1490-1495.

[7]Misiani R, Bellavita P, Fenili D, et al.Hepatitis C virus infec-tion in patients with essential mixed cryoglobulinemia[J].Ann Intern Med, 1992, 117 (7) :573-577.

[8]Gorevic PD, Frangione B.Mixed cryoglobulinemia crossreac-tive idiotypes:Implications for the relationship of MC to rheu-matic and lymphoproliferative diseases[J].Semin Hematol, 1991, 28 (2) :79-94.

[9]Padmanabhan P, Dixit NM.Mathematical model of viral ki-netics in vitro estimates the number of E2-CD81 complexesnecessary for hepatitis C virus entry[J].PLoS Comput Biol, 2011, 7 (12) :e1002307.

[10]Monti G, Pioltelli P, Saccardo F, et al.Incidence and charac-teristics of non-Hodgkin lymphomas in a multicenter casefile of patients with hepatitis C virus-related symptomaticmixed cryoglobulinemias[J].Arch Intern Med, 2005, 165 (1) :101-105.

[11]Kayali Z, Buckwold VE, Zimmerman B, et al.Hepatitis C, cryoglobulinemia, and cirrhosis:a meta-analysis[J].Hep-atology, 2002, 36 (4) :978-985.

[12] Sène D, Limal N, Cacoub P. Hepatitis C virus-associated extrahepatic manifestations: a review[J]. Metab Brain Dis, 2004, 19 (3-4) : 357-381.

[13] Iannuzzella F, Vaglio A, Garini G. Management of hepatitis C virus-related mixed cryoglobulinemia [J]. Am J Med, 2010, 123 (5) : 400-408.

[14]Ferri C, Sebastiani M, Giuggioli D, et al.Mixed cryoglobu-linemia:demographic, clinical, and serologic features andsurvival in 231 patients[J].Semin Arthritis Rheum, 2004, 33 (6) :355-374.

[15]Groves C, Devereux C, McMillan C.A case of cutaneous vas-culitis with underlying hepatitis C and cryoglobulinaemia[J].Ul-ster Med J, 2008, 77 (1) :51-53.

[16]Lo KY, Chen CY, Lee CS.Hepatitis C virus-associated typeII mixed cryoglobulinemia vasculitis complicated with mem-branous proliferative glomerulonephritis[J].Ren Fail, 2009, 31 (2) :149-152.

[17]Morales JM, Kamar N, Rostaing L.Hepatitis C and renal dis-ease:epidemiology, diagnosis, pathogenesis and therapy[J].Contrib Nephrol, 2012, 176:10-23.

[18]Zaltron S, Puoti M, Liberini P, et al.High prevalence of pe-ripheral neuropathy in hepatitis C virus infected patients withsymptomatic and asymptomatic cryoglobulinemia[J].Ital JGastroent erol Hepatol, 1998, 30 (4) :391-395.

[19]Boukhris S, Magy L, Senga-mokono U, et al.Polyneurop-athy with demyelinating features in mixed cryoglobulinemiawith hepatitis C virus infection[J].Eur J Neurol, 2006, 13 (9) :937-941.

[20]Alpa M, Ferrero B, Cavallo R, et al.Anti-neuronal antibod-ies in patients with HCV-related mixed cryoglobulinemia[J].Autoimmun Rev, 2008, 8 (1) :56-58.

[21]Lee YH, Ji JD, Yeon JE, et al.Cryoglobulinemia and rheu-matic manifestations in patients with hepatitis C virus infec-tion[J].Ann Rheum Dis, 1998, 57 (12) :728-731.

[22]Sene D, Ghillani-Dalbin P, Limal N, et al.Anti-cyclic cit-rullinated peptide antibodies in hepatitis C virus associatedrheumatological manifestations and Sj gren’s syndrome[J].Ann Rheum Dis, 2006, 65 (3) :394-397.

[23]Gisbert JP, Garcia-Buey L, Pajares JM, et al.Prevalence ofhepatitis C virus infection in B-cell non-Hodgkin’s lympho-ma:systematic review and meta-analysis[J].Gastroenter-ology, 2003, 125 (6) :1723-1732.

[24] Wang CC, Kao JH. Hepatitis C virus infection, lipids, and coronary heart disease: a Pandora's box[J]. Hepatology, 2010, 51 (1) : 343-344.

[25] Aliannejad R, Ghanei M. Hepatitis C and pulmonary fibrosis: Hepatitis C and pulmonary fibrosis [J]. Hepat Mon, 2011, 11 (2) : 71-73.

[26] Kallemuchikkal U, Gorevic PD. Evaluation of cryoglobulins[J]. Arch Pathol Lab Med, 1999, 123 (2) : 119-125.

[27] NIH Consensus Statement on Management of Hepatitis C: 2002[J]. NIH Consens State Sci Statements, 2002, 19 (3) : 1-46.

[28]Fried MW, Shiffman ML, Reddy KR, et al.Peginterferon al-fa-2a plus ribavirin for chronic C virus infection[J].N EnglJ Med, 2002, 347 (13) :975-982.

[29]Campise M, Tarantino A.Glomerulonephritis in mixed cryo-globulinemia:what treatment?[J].Nephrol Dial Transplant, 1999, 14 (2) :281-283.

[30]Pietrogrande M, De Vita S, Zignego AL, et al.Recommen-dations for the management of mixed cryoglobulinemia syn-drome in hepatitis C virus-infected patients[J].AutoimmunRev, 2011, 10 (8) :444-454.

[31] Won D, Park CJ, Chang JW. Cryoglobulinemic vasculitis and monoclonal gammopathy in end-stage renal disease[J]. Korean J Hematol, 2011, 46 (4) : 215.

[32]Koukoulaki M, Jayne DR.Mycophenolate mofetil in anti-neu-trophil cytoplasm antobodies-associated systemic vasculitis[J].Nephron Clin Pract, 2006, 102 (3-4) :c100-107.

[33] Ramos-Casals M, Font J. Mycophenolate mofetil in patients with hepatitis C virus infection [J]. Lupus, 2005, 14 (Suppl 1) : s64-s72.

[34] Laurino S, Borrelli S, Catapano F, et al. Treatment of HCV-associated cryoglobulinemic glomerulonephritis[J]. G Ital Nefrol, 2009 , 26 (3) : 318-327.

[35] Pons-Estel GJ, Salerni GE, Serrano RM, et al. Therapeutic plasma exchange for the management of refractory systemic autoimmune diseases: report of 31 cases and review of the literature[J]. Autoimmun Rev, 2011, 10 (11) : 679-684.

[36]Ramunni A, Lauletta G, Brescia P, et al.Double-filtrationplasmapheresis in the treatment of leg ulcers in cryoglobu-linemia[J].J Clin Apher, 2008, 23 (3) :118-122.

[37]Ferri C, Cacoub P, Mazzaro C, et al.Treatment with ritux-imab in patients with mixed cryoglobulinemia syndrome:re-sults of multicenter cohort study and review of the literature[J].Autoimmun Rev, 2011, 11 (1) :48-55.

[38]Dammacco F, Tucci FA, Lauletta G, et al.Pegylated inter-feron-alpha, ribavirin, and rituximab combined therapy ofhepatitis Cvirus-related mixed cryoglobulinemia:a long-term study[J].Blood, 2010, 116 (3) :343-353.

[39]Booth A, Harper L, Hammad T, et al.Prospective study ofTNFalpha blockade with infliximab in anti-neutrophil cyto-plasmic antibody-associated systemic vasculitis[J].J AmSoc Nephrol, 2004, 15 (3) :717-721.

[40]Galeazzi M, Bellisai F, Giannitti C, et al.Safety of cyclospor-in A in HCV-infected patients experience with cyclosporin Ain patients affected by disorders and concomitant HCV infec-tion[J].Ann N Y Acad Sci, 2007, 1110:544-549.

[41]Attal N, Cruccu G, Baron R, et al.EFNS guidlines on phar-macological treatment of neuropathic pain:2010 Revision[J].Eur J Neurol, 2010, 17 (9) :1113-1123.

[42]Lo Gullo R, De Filippis L, Caliari A, et al.Successful treat-ment of necrotizing vasculitic lesions after infusion of iloprostin a patient with cryoglobulinemia and chronic HCV infection[J].Clin Exp Rheumatol, 2005, 23 (6) :912-913.

[43]Monti G, Saccardo F, Rinaldi G, et al.Colchicine in the treat-ment of mixed cryoglobulinemia[J].Clin Exp Rheumatol, 1995, 13 (Suppl 13) :s197-s199.

[44]Bruchfeld A, Lindahl K, Stahle L, et al.Interferon and ribavi-rin treatment in patients with hepatitis C-associated renaldisease and renal insufficiency[J].Nephrol Dial Transplant, 2003, 18 (8) :1573-1580.

[45]Saadoun D, Resche Rigon M, Sene D, et al.Rituximab plusPeg-interferon-alpha/ribavirin compared with Peg-inter-feron-alpha/ribavirin in hepatitis C-related mixed cryoglob-ulinemia[J].Blood, 2010, 116 (3) :326-334.

施引文献

资源附件(0)

访问统计