慢性丙型肝炎患者抗病毒治疗前后血清冷球蛋白的变化

Changes of serum cryoglobulin levels after antiviral treatment in patients with chronic hepatitis C virus

目的探讨慢性丙型肝炎患者抗病毒治疗前后血清冷球蛋白的变化。方法对81例慢性丙型肝炎患者(分为冷球蛋白阳性组32例,阴性组49例)应用聚乙二醇干扰素α-2a联合利巴韦林治疗,检测治疗前、治疗后12周、48周及治疗结束后24周患者血清HCV RNA和冷球蛋白,观察治疗前后冷球蛋白变化及与干扰素疗效的关系。结果①81例慢性丙型肝炎患者中32例冷球蛋白阳性,阳性率为39.5%(32/81)。冷球蛋白阳性组年龄、HCV RNA定量高于阴性组(P<0.05)。②冷球蛋白阳性组早期病毒学应答(EVR)、持续病毒学应答(SVR)均低于阴性组(P<0.05)。③冷球蛋白阳性组干扰素治疗后12周、48周及治疗结束后24周,冷球蛋白检出率均较治疗前下降(P<0.05);冷球蛋白阳性组中SVR组治疗12周、48周及治疗结束后24周冷球蛋白检出率均低于非SVR组(P<0.05)。结论慢性丙型肝炎合并冷球蛋白阳性的患者抗病毒应答率低于阴性组,经过抗病毒治疗能明显降低冷球蛋白水平。

Objective To investigate the changes of serum cryoglobulins before and after antiviral treatment in patients with chronic hepatitis C. Methods Eighty-one patients with hepatitis C were treated with polyethylene glycol interferon α- 2a combined with ribavirin. Then HCV RNA and cryoglobulins in serum were detected before treatment,after treatment for 12 weeks,48 weeks,and at 24 week after drug withdrawal. The changes of serum cryoglobulins before and after treatment were observed and the relationship with the effect of interferon was explored. Results Of 81 patients with chronic hepatitis C,32 were found cryoglobulin positive and the positive rate was 39. 5%. Age and quantitative HCV RNA in cryoglobulin positive group were higher than in negative group（P 〈 0. 05）. Early virological response（EVR） and sustained virological response（SVR） in cryoglobulin positive group were lower than in negative group（P〈 0. 05）. At 12 week,48 week after interferon treatment and 24 week after drug withdrawal,the cryoglobulin detection rates were lower than that before treatment in cryoglobulin positive group（P 〈 0. 05）. In cryoglobulin positive patients,the cryoglobulin detection rates were lower in SVR group than in non-SVR group at 12 week,48 week after treatment and at 24 week after drug withdrawal（P 〈 0. 05）. Conclusion The antiviral response positive rate in cryoglobulin positive patients with chronic hepatitis C is lower than that of the negative,which suggest that the antiviral therapy can significantly reduce serum cryoglobulin level.