抗病毒治疗对慢性丙型肝炎合并冷球蛋白血症早期肾损伤的影响

摘要

目的：探讨抗病毒治疗对慢性丙型肝炎合并冷球蛋白血症早期肾损伤的影响。方法收集2007年2月-2013年2月在玉田县医院及石家庄市第五医院就诊的81例慢性丙型肝炎患者的临床资料，分为冷球蛋白阳性组(32例)、冷球蛋白阴性组(49例)，均予以聚乙二醇干扰素α-2a联合利巴韦林抗病毒治疗，观察治疗前、治疗结束及停药后24周尿微量蛋白(UmAlb)水平的变化。结果冷球蛋白阳性组持续病毒学应答(SVR)46.9%(15/32)低于阴性组75.5%(37/49)(P<0.05)；冷球蛋白阳性组治疗前、治疗结束及停药后24周UmAlb均高于冷球蛋白阴性组(P<0.05)；冷球蛋白阳性组UmAlb治疗结束较治疗前下降，但停药后24周又较治疗结束时上升(P<0.05)。冷球蛋白阳性患者SVR组UmAlb治疗结束及停药后24周较治疗前显著下降(P<0.05)，非SVR组UmAlb治疗结束较治疗前下降，但停药后24周又较治疗结束时上升(P<0.05)，且SVR组治疗结束及停药后24周Um-Alb均低于非SVR组(P<0.05)。结论抗病毒治疗可以明显改善慢性丙型肝炎合并冷球蛋白血症早期肾损伤，尤其是获得持续病毒学应答患者受益更显著。%Objective To investigate the effects of antiviral therapy on chronic hepatitis C with early renal injury of cryoglobulinemia. Methods Clinical datas of 81 patients with chronic hepatitis C in the Fifth Hospital in Shijiazhuang City and Yutian County Hospital in Hebei Province were collected from Feb. 2007 to Feb. 2013. Two groups were di-vided including 32 cold globulin positive cases and 49 cryoglobulins negative patients and treated with antiviral therapy with peginterferon α-2a and ribavirin. The changes of microal buminuria ( UmAlb) levels were observed before treat-ment, end of treatment and 24 weeks after discontinuation. Results Virologic response ( SVR) in cryoglobulin positive group (15/32, 46. 9%) was lower than that in cryoglobulin negative group (37/49, 75. 5%) (P<0. 05);UmAlb lev-el in cryoglobulin positive group was higher than that in cryoglobulin negative group before treatment, end of treatment and 24 weeks after discontinuation ( P<0 . 05 );UmAlb level in cryoglobulin positive group at the end of treatment was lower than that before treatment, but increased again 24 weeks after discontinuation compared with the end of treatment ( P<0 . 05 ) . UmAlb level in SVR group of cryoglobulin positive patients decreased at the end of treatment and 24 weeks after discontinuation ( P<0 . 05 ); UmAlb level in non SVR group at the end of treatment was lower than before treat-ment, but increased again 24 weeks after discontinuation (P<0. 05);UmAlb levels in SVR group was lower than that in non SVR group at the end of treatment and 24 weeks after discontinuation. Conclusion Antiviral therapy for chronic hepatitis C can significantly improve the combined cryoglobulinemia early kidney damage, especially in patients with sustained virologic response.