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首页> 外文期刊>Hemodialysis international >Treatment of hepatitis C virus infection in patients with mixed cryoglobulinemic syndrome and cryoglobulinemic glomerulonephritis
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Treatment of hepatitis C virus infection in patients with mixed cryoglobulinemic syndrome and cryoglobulinemic glomerulonephritis

机译：混合冷冻纤维素综合征患者丙型肝炎病毒感染和冷冻纤维素肾小球肾炎的治疗方法

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Cryoglobulinemia is a common extrahepatic manifestation of infection with hepatitis C virus (HCV). When signs and symptoms of systemic vasculitis or glomerulonephritis occur in the presence of circulating cryoglobulins, this syndrome is called mixed cryoglobulinemia syndrome (MCS). Historically, interferon-based therapies in HCV have been associated with lower rates of viral cure in patients with MCS than in the general HCV-infected population. The advent of direct-acting antiviral therapies have revolutionized the treatment of HCV, dramatically increasing rates of cure. Early studies of first-generation protease inhibitors (telaprevir and boceprevir) in combination with interferon and ribavirin demonstrated HCV cure rates of 67% and complete clinical response rates of vasculitis symptoms in 60% of patients with MCS; however, regimens were poorly tolerated by patients, 22% discontinued treatment early. More recently, all-oral, interferon-free regimens have become available and combination therapies are now being approved for patients with and without renal impairment. Patients with HCV-MCS achieved sustained virologic response in 297 out of 313 patients (95%) treated with direct-acting antiviral therapy, and 85% had a complete or partial clinical response of MCS symptoms. Current direct-acting antiviral therapies are well tolerated in patients with HCV-MCS and only 1.6% discontinued treatment early. Patients with cryoglobulinemic glomerulonephritis also had an excellent cure rate (94%). The majority improved; 17/52 (33%) experienced full remission and 15/52 (29%) experienced partial remission. There were no reports of worsening kidney function in patients treated with direct-acting antiviral therapies. Less than 5% of patients with HCV-MCS treated with IFN-free direct-acting antiviral therapy required immunosuppression. However, patients with severe vasculitis appear to still require concomitant immunosuppression.
机译：Tryoglobobulinemia是丙型肝炎病毒（HCV）感染的常见侵略性表现。当在存在循环干酪菌素的存在下出现全身血管炎或肾小球肾炎的症状和症状时，这种综合征称为混合干冰蛋白血症综合征（MCS）。从历史上看，HCV的干扰素疗法已经与MCS患者的病毒治疗率较低而不是在一般的HCV感染的人群中有关。直接作用抗病毒疗法的出现彻底改变了HCV的治疗，显着增加了治愈率。第一代蛋白酶抑制剂（TelaPrevir和Boceprevir）与干扰素和利巴韦林组合的早期研究表明HCV治愈率为67％，并在60％的MCS患者中完成血管炎症状的完整临床反应率;然而，方案被患者耐受性差，早期停产22％。最近，全口服，无干扰素的方案已成为可用，并且现在正在批准组合治疗，患者因肾脏损伤而批准。 HCV-MCS的患者在313名患者中的297名（95％）中获得了持续的病毒学反应（95％），并且85％的MCS症状具有完整或部分临床反应。目前的直接作用抗病毒疗法在HCV-MCS患者中耐受良好，并且早期只停产1.6％。含有肾上腺素肾小球肾细胞肾炎的患者也具有优异的固化率（94％）。大多数改善; 17/52（33％）经历了全额缓解，15/52（29％）经历了部分缓解。在用直接作用抗病毒疗法治疗的患者中没有报道恶化肾功能。不到5％的HCV-MCS患者，用IFN的直接作用抗病毒治疗需要免疫抑制。然而，严重血管炎的患者似乎仍然需要伴随的免疫抑制。

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