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Abstract：
BACKGROUND: Hepatitis B virus (HBV) infection is a rare etiology of cryoglobulinemia, and its clinical characteristics, virological features and treatment are poorly understood.
METHODS: This retrospective study enrolled 23 patients with HBV-related cryoglobulinemia from 497 cryoglobulinemia patients at Peking Union Medical College Hospital between January 2015 and February 2023. We analyzed the clinical characteristics, virological features and management of patients with HBV-related cryoglobulinemia.
RESULTS: The 23 patients (13 males; median age 48 years) were all mixed cryoglobulinemia and serological HBsAg positive, while 15 patients exhibited HBV-DNA replication. The presence of HBsAg in cryoglobulins was evaluated in 7 patients, all of whom were positive. The most commonly involved organs were kidneys (69.6%), skin (65.2%), peripheral nerves (21.7%), joints (8.7%), gastrointestinal tract (4.3%), and cardiac (4.3%). Eight patients received antiviral therapy with nucleot (s)ide analogues (NAs) alone, 12 patients received NA- and corticosteroid-based regimens, and 3 patients received NA- and rituximab-based regimens based on the severity of clinical symptoms. After a median follow-up of 44 months, four patients died, and one patient was lost to follow-up. All remaining patients (n = 18) achieved clinical remission, and HBV-DNA replication was not detected in 16 out of 18 patients. There was no HBV reactivation in patients treated with rituximab. The three-year overall survival and progression-free survival were 87.0% and 80.3%, respectively.
CONCLUSIONS: HBV-related cryoglobulinemia patients should be treated with antiviral therapy. Corticosteroids and rituximab are effective for severe cases, but patients need to be closely monitored for therapy-related infection.
METHODS: This retrospective study enrolled 23 patients with HBV-related cryoglobulinemia from 497 cryoglobulinemia patients at Peking Union Medical College Hospital between January 2015 and February 2023. We analyzed the clinical characteristics, virological features and management of patients with HBV-related cryoglobulinemia.
RESULTS: The 23 patients (13 males; median age 48 years) were all mixed cryoglobulinemia and serological HBsAg positive, while 15 patients exhibited HBV-DNA replication. The presence of HBsAg in cryoglobulins was evaluated in 7 patients, all of whom were positive. The most commonly involved organs were kidneys (69.6%), skin (65.2%), peripheral nerves (21.7%), joints (8.7%), gastrointestinal tract (4.3%), and cardiac (4.3%). Eight patients received antiviral therapy with nucleot (s)ide analogues (NAs) alone, 12 patients received NA- and corticosteroid-based regimens, and 3 patients received NA- and rituximab-based regimens based on the severity of clinical symptoms. After a median follow-up of 44 months, four patients died, and one patient was lost to follow-up. All remaining patients (n = 18) achieved clinical remission, and HBV-DNA replication was not detected in 16 out of 18 patients. There was no HBV reactivation in patients treated with rituximab. The three-year overall survival and progression-free survival were 87.0% and 80.3%, respectively.
CONCLUSIONS: HBV-related cryoglobulinemia patients should be treated with antiviral therapy. Corticosteroids and rituximab are effective for severe cases, but patients need to be closely monitored for therapy-related infection.
摘要：
背景：乙型肝炎病毒（HBV）感染是冷球蛋白血症的罕见病因，及其临床特征，病毒学特征和治疗方法知之甚少。
方法：这项回顾性研究纳入了2015年1月至2023年2月在北京协和医院就诊的497例冷球蛋白血症患者中的23例HBV相关冷球蛋白血症患者。我们分析了临床特征，HBV相关冷球蛋白血症患者的病毒学特征和管理。
结果：23例患者（13例男性，中位年龄48岁）均为混合型冷球蛋白血症和血清学HBsAg阳性，而15例患者表现出HBV-DNA复制。在7例患者中评估了冷球蛋白中HBsAg的存在，他们都是积极的。最常见的器官是肾脏（69.6％），皮肤（65.2%），周围神经（21.7%），接头(8.7%)，胃肠道（4.3%），和心脏(4.3%)。8例患者接受抗病毒治疗与nucleot（s）类似物（NAs）单独，12例患者接受了基于NAs和皮质类固醇的方案，3例患者根据临床症状的严重程度接受了基于NA和利妥昔单抗的治疗方案.经过44个月的中位随访，四名病人死亡,一名患者失去随访。其余所有患者（n=18）均达到临床缓解，18例患者中有16例未检测到HBV-DNA复制。利妥昔单抗治疗的患者没有HBV再激活。3年总生存率和无进展生存率分别为87.0%和80.3%,分别。
结论：HBV相关冷球蛋白血症患者应接受抗病毒治疗。皮质类固醇和利妥昔单抗对严重病例有效，但是需要密切监测患者的治疗相关感染。
方法：这项回顾性研究纳入了2015年1月至2023年2月在北京协和医院就诊的497例冷球蛋白血症患者中的23例HBV相关冷球蛋白血症患者。我们分析了临床特征，HBV相关冷球蛋白血症患者的病毒学特征和管理。
结果：23例患者（13例男性，中位年龄48岁）均为混合型冷球蛋白血症和血清学HBsAg阳性，而15例患者表现出HBV-DNA复制。在7例患者中评估了冷球蛋白中HBsAg的存在，他们都是积极的。最常见的器官是肾脏（69.6％），皮肤（65.2%），周围神经（21.7%），接头(8.7%)，胃肠道（4.3%），和心脏(4.3%)。8例患者接受抗病毒治疗与nucleot（s）类似物（NAs）单独，12例患者接受了基于NAs和皮质类固醇的方案，3例患者根据临床症状的严重程度接受了基于NA和利妥昔单抗的治疗方案.经过44个月的中位随访，四名病人死亡,一名患者失去随访。其余所有患者（n=18）均达到临床缓解，18例患者中有16例未检测到HBV-DNA复制。利妥昔单抗治疗的患者没有HBV再激活。3年总生存率和无进展生存率分别为87.0%和80.3%,分别。
结论：HBV相关冷球蛋白血症患者应接受抗病毒治疗。皮质类固醇和利妥昔单抗对严重病例有效，但是需要密切监测患者的治疗相关感染。
