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目的 观察慢性丙型病毒性肝炎(CHC)冷球蛋白血症患者血清中CXC趋化因子10(CXCL-10)的水平及其对抗病毒治疗效果的影响.方法 应用冷沉淀法检测50例CHC患者治疗前血清中冷球蛋白血症的性质,酶联免疫吸附法检测患者血清CXCL-10浓度,并检测患者丙型肝炎病毒(HCV)基因型、基线水平、治疗后4、12、24周、治疗结束与治疗结束后24周血清中HCV RNA的水平.连续型变量用独立样本t检验或秩和检验,分类资料用x2、Fisher1s精确概率法,P＜0.05为差异有统计学意义. 结果 冷球蛋白血症阳性患者的基线HCV RNA为(6.28±0.79) log1o拷贝/ml,高于冷球蛋白血症阴性患者的(5.48±1.20) log1o拷贝/ml,t=-2.769,P=0.009,差异有统计学意义;基线CXCL-10水平为(541.67±224.07) pg/ml,也明显高于冷球蛋白阴性患者的(394.39±179.71) pg/ml,t=-2.533,P=0.015,差异有统计学意义.聚乙二醇干扰素α-2a联合利巴韦林治疗后,冷球蛋白阳性患者获得快速病毒学应答的比例为33.3％,低于冷球蛋白阴性患者的82.6％,P＜0.001,差异有统计学意义.持续病毒学应答率在冷球蛋白阳性患者也显著低于冷球蛋白阴性患者(33.3％对比78.3％),x2=12.239,P=0.001,差异有统计学意义.结论 冷球蛋白阳性患者血清HCV RNA及CXCL-10水平高于阴性患者,且疗效低.“,”Objective To investigate the serum CXCL-10 level in chronic hepatitis C (CHC) patients with cryoglobulinemia and its influence on the effect of antiviral therapy.Methods A total of 50 CHC patients were enrolled in the study.Cryoprecipitation was used to determine the nature of cryoglobulins in serum before treatment,and ELISA was used to measure the serum CXCL-10 level.The hepatitis C virus (HCV) genotype was detected,and serum HCV RNA level was measured at baseline,4,12,and 24 weeks of treatment,the end of treatment,and 24 weeks after treatment..Results Compared with the cryoglobulin-negative patients,the cryoglobulin-positive patients had significantly higher baseline levels of HCV RNA [(6.28±0.79) logl0 copies/ ml vs (5.48±1.20) log10 copies/ml,P =0.009] and CXCL-10 (541.67±224.07 pg/ml vs 394.39±179.71 pg/ ml,P =0.015).After the treatment with pegylated interferon-α-2a and ribavirin,the cryoglobulin-positive patients had a significantly lower proportion of individuals who achieved rapid virological response compared with the cryoglobulin-negative patients (33.3％ vs 82.6％,P ＜ 0.001).The cryoglobulin-positive patients had a significantly lower rate of sustained virologic response than the cryoglobulin-negative patients (33.3％ vs 78.3％,P =0.001).Conclusion The patients with cryoglobulinemia have higher serum levels of HCV RNA and CXCL-10 and poor outcomes compared with those without cryoglobulinemia.