临床经验 Open Access
Copyright ©The Author(s) 2005. Published by Baishideng Publishing Group Inc. All rights reserved.
世界华人消化杂志. 2005-12-28; 13(24): 2889-2891
在线出版日期: 2005-12-28. doi: 10.11569/wcjd.v13.i24.2889
延边地区慢性丙型肝炎患者血清中自身抗体的检测及其临床意义
许顺姬, 韩学吉, 朴红心
许顺姬, 延边大学医学院附属医院检验科 吉林省延吉市 133000
韩学吉, 朴红心, 延边大学医学院附属医院感染科 吉林省延吉市 133000
通讯作者: 许顺姬, 133000, 吉林省延吉市局子街119号, 延边大学医学院附属医院检验科. xsj64@hanmail.net
电话: 0433-2660109
收稿日期: 2005-11-08
修回日期: 2005-11-25
接受日期: 2005-12-02
在线出版日期: 2005-12-28

目的: 分析延边地区慢性丙型肝炎患者血清中自身抗体阳性率及其临床意义.

方法: 选择100名慢性丙型肝病患者(慢性79例, 肝硬化21例), 检测自身抗体(ALC, ANA, ASA, AMA, RF)阳性率, 并比较自身抗体(+)及自身抗体(-)群年龄、性别、肝功能状态.

结果: 慢性丙型肝炎患者血清中自身抗体至少一种阳性的62例. ACL阳性40例最多, 其次为ANA阳性29例, RF阳性19例, ASA阳性8例, AMA阳性3例. 另外, 自身抗体阳性组和阴性组有关因素比较发现, 自身抗体阳性组比阴性组年龄较大(58.7岁 vs 49.7岁)、女性多见(79.2% vs 46.2%)、肝功能及肝病状态差.

结论: 慢性丙型肝炎患者血清中常出现自身抗体, 自身抗体出现可影响肝功能状态, 加重病情, 在临床诊疗中应慎重.

关键词: 自身抗体; 丙型肝炎
引文著录: 许顺姬, 韩学吉, 朴红心. 延边地区慢性丙型肝炎患者血清中自身抗体的检测及其临床意义. 世界华人消化杂志 2005; 13(24): 2889-2891
Detection and clinical significance of autoantibodies in serum of patients with chronic Hepatitis C in Yanbian area
Shun-Ji Xu, Xue-Ji Han, Hong-Xin Piao
Shun-Ji Xu, Department of Laboratory, the Affiliated Hospital of Medicine College, Yanbian University, Yanji 133000, Jilin Province, China
Xue-Ji Han, Hong-Xin Piao, Department of Infectious Diseases, the Affiliated Hospital of Medicine College, Yanbian University, Yanji 133000, Jilin Province, China
Correspondence to: Department of Laboratory, the Affiliated Hospital of Medicine College, Yanbian University, 119 Juzi Street, Yanji 133000, Jilin Province, China. xsj64@hanmail.net
Received: November 8, 2005
Revised: November 25, 2005
Accepted: December 2, 2005
Published online: December 28, 2005

AIM: To analyze the positive rate of autoantibodies in patients with chronic chronic Hepatitis C and their clinical significances.

METHODS: The positive rate of autoantibodies including anti-cardiolipin (ALC), antinuclear (ANA), anti-smooth muscle (ASA), antimitochondrial (AMA) antibodies, and rheumatiod factor (RF) were detected in 100 patients with chronic Hepatitis C (79 chronic hepatitis C, 21 liver cirrhosis). And the factors such as age, gender, and liver function, between patients with autoantibodies positive and negative were compared.

RESULTS: The overall positive rate of the autoantibodies was 62.0%. The positive rate of ACL, ANA, RF, ASA, and AMA was 40.0%, 29.0%, 19.0%, 8.0%, and 3.0%, respectively. As compared with the autoantibody-negative patients, the autoantibody-positive patients were order (58.7 vs 49.7), and with worse liver function and disease status. The positive expression of autoantibody was found higher in females than those in males (79.2% vs 46.2%).

CONCLUSION: The autoantibodies are commonly found in patients with chronic hepatitis C. Its presence may infect the status of the liver function and aggravate the state of the disease.

Key Words: Autoantibody; Hepatitis C virus
0 引言

慢性丙型肝炎的发病与免疫因素有关, 且与很多免疫性疾病有关. 另外, 慢性丙型肝炎患者血清中常出现自身抗体[1]. 目前对慢性丙型肝炎患者血清中出现自身抗体是否影响ALT上升及肝组织损伤, 各家研究结果不一[1-3]. 我们分析了延边地区慢性丙型肝炎患者血清中自身抗体阳性率及其临床意义, 这对以后的治疗及判定预后具有重要意义.

1 材料和方法
1.1 材料

从2002/2004-02本院住院的慢性丙型肝病患者100例. 其中慢性肝炎79例, 合并肝硬化21例, 平均年龄: 54.4±7.8岁, 男52例、女48例. 均为抗HCV(+), HCV-RNA(+), HBsAg(-), 未接受干扰素治疗的患者. 诊断符合2000年病毒性肝炎防治方案[4].

1.2 方法

抗核抗体(ANA), 抗平滑肌抗体(ASA), 抗线粒体抗体(AMA), 类风湿因子(RF)检测采用间接免疫荧光法(FLUORO HEPANA test kit MBL, Nagoya, Japan).抗心磷脂抗体(ACL)检测采用放免法(Imulyse ACA kit. Biopool, USA). 抗HCV, HBsAg检测采用ELISA法, HCV-RNA检测采用实时 PCR.

统计学处理 利用SPSS10.0统计处理系统, 两组间比较采用t检验.

2 结果

慢性丙型肝炎患者血清中自身抗体至少一个阳性的62例占62.0%, 其中, 男24例(46.2%), 女38例(79.2%). ACL阳性40例(40.0%)最多, 其次为ANA阳性29例(29.0%), RF阳性19例(19.0%), ASA阳性8例(8.0%), AMA阳性3例(3.0%). 女性患者每一种自身抗体阳性率均高于男性(表1).

表1 100例慢性丙型肝炎患者血清中自身抗体的检测.
男(%)(n = 52)女(%)(n = 48)共(%)(n = 100)
自身抗体24(46.2)38(79.2)62(62.0)
ACL15(28.8)25(52.1)40(40.0)
ANA11(21.2)18(37.5)29(29.0)
RF9(17.3)10(20.8)19(19.0)
ASA3(5.8)5(10.4)8(8.0)
AMA1(1.9)2(4.2)3(3.0)

另外, 自身抗体阳性组和阴性组有关因素比较中发现, 自身抗体阳性组比阴性组年龄较大(58.7岁 vs 49.7岁)、女性多见(79.2% vs 46.2%)、肝功能(ALT、AST、ALB)状态差(表2).

表2 自身抗体(+)及自身抗体(-)群年龄, 性别, 肝功比较.
自身抗体(+)自身抗体(-)
(n = 62)(n = 38)
年龄58.7±10.149.7±9.2a
性别(M/F)24/3828/10
ALT(nkat/L)873.7±1168.61248.6±926.9a
AST(nkat/L)2143.8±1146.91405.3±1095.2a
ALB(g/L)28.3±4.235.5±4.7a
aP＜0.05 vs 自身抗体(+)
3 讨论

慢性丙型肝炎的发病与免疫因素有关, 且与很多免疫性疾病有关[1,5,6]. 另外, 血清中自身抗体出现时ALT明显上升[1], 其组织学改变类似与自身免疫性肝炎[2], 但也有报道两者间组织学改变及血清 ALT 无差异[3]. 本研究结果显示, 慢性丙型肝炎患者血清中自身抗体出现率比较高(62.0%), 其中ACL阳性占40.0%, 比西方国家的报告高, 而ANA阳性率(29.0%)ASA阳性率(8.0%)RF阳性率(19.0%)均比西方国家的报告[1,7]很低. 本研究结果及以往的研究结果相比, 有一些差异, 这可能与不同的地区, 不同的种族的HCV基因类型不同有关[8,9]. 另外, 本研究结果显示, 自身抗体阳性组比阴性组年龄较大(58.7岁 vs 49.7岁)、女性多见(79.2% vs 46.2%), 这与Kim et al[10]研究结果相似, 提示血清自身抗体出现可能与衰老、女性内分泌失调有关. 另外, 自身抗体阳性组比阴性组肝功能(ALT、AST、ALB)状态差.这些临床表现可能与多种致病因素参与自身抗体阳性慢性丙型肝炎患者肝脏损伤有关. 环磷酰胺是一种细胞周期非特异性细胞毒性药物, 促使免疫反应从Th2向Th1转变, 具有强烈抑制体液反应的作用, 自50年代应用临床以来, 越来越广泛应用于自身免疫治病的治疗[11], 治疗自身免疫性肝病疗效可靠, 副作用相对小[12]. 治疗部分病毒性相关性脏器损伤疾病获得较好疗效[13,14]. 程鹏et al[15]研究发现, 对ANA阳性肝硬化患者应用环磷酰胺可以减轻临床表现, 但临床应用要严格掌握适应症. 环磷酰胺能否减轻自身抗体阳性慢性丙型肝炎患者临床表现, 有待与进一步研究.

电编: 张勇 编辑: 菅鑫妍 审读: 张海宁

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