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本文报道了1例老年男性患者,临床上存在皮肤紫癜伴肾脏损害,冷球蛋白升高,类风湿因子高滴度阳性,同时伴免疫球蛋白IgM升高,丙型肝炎抗体及RNA阴性。两年前第1次入住我科行肾活检误诊为膜增生性肾小球肾炎。患者虽经免疫抑制剂治疗病情改善,但此次停药3月后病情活动,尿检异常加重,肾功能恶化,再次入院后查冷球蛋白明显升高,重新仔细阅病理片后修正诊断为冷球蛋白血症肾损害,后经双重滤过血浆置换联合激素治疗,病情得到改善。本文通过分析此例非HCV相关冷球蛋白血症的诊治经过,以期提高临床医师对冷球蛋白血症特点的认识,避免贻误诊治,并进一步探求这类疾病更好的治疗方案。
This article reports a case of elderly male patients, the clinical presence of skin purpura with renal damage, cold globin protein, rheumatoid factor high titer positive, accompanied by elevated immunoglobulin IgM, hepatitis C antibody and RNA negative. My first visit two years ago, my renal biopsy misdiagnosed as membranoproliferative glomerulonephritis. Although patients treated by immunosuppressive therapy to improve their condition, but the withdrawal of the disease after 3 months of activity, abnormal urine test, renal dysfunction, check cold ball globulin again after admission was significantly increased, re-read pathology after revision diagnosis was cold Kidney damage of globulin, after double filtration plasma exchange combined with hormone therapy, the condition has been improved. In this paper, we analyzed the diagnosis and treatment of non-HCV associated cryoglobulinemia in order to improve clinicians’ understanding of the characteristics of cryoglobulinemia, avoid delaying the diagnosis and treatment, and further explore better treatment options for such diseases.