测定各型HBV感染者血清和肝脏β_2微球蛋白的临床意义

Clinical significance of detecting serum and liverβ_2 microglobulin in patients with various types of HBV infection

目的动态观察各型HBV感染者血清β2微球蛋白(β2MG)水平及肝内表达的临床意义。方法HBV感染者128例中,无症状携带者(ASC)12例,急性肝炎(AH)26例,慢性肝炎(CH)56例,重型肝炎(SH)18例,肝硬变(LC)和原发性肝癌(HCC)各8例。正常对照组30例,用RIA和免疫组化法分别测定血清和肝内β2MG,与肝损害程度比较,分析临床意义。结果除ASC外,各型乙肝和LC,HCC血清β2MG均有升高,其中,以SH,LC,CH和HCC为著;AH,SH肝细胞β2MG表达明显增强(正常肝细胞不表达),且其分布与肝组织炎症坏死区一致。血清β2MG水平和肝内表达强度与血清胆红素水平呈正相关。动态观察发现,AH于恢复期血清β2MG降至接近正常,SH死亡组β2MG水平明显高于存活组。结论β2MG参与HBV感染发病机制中肝组织免疫病理损害过程,动态观察血清β2MG水平可在一定程度上反映AH和SH的预后和转归。

Objective To observe the clinical significance of β2 microglobulin(β2 MG)and its role in pathogenesis in various types of hepatitis B virus infection.Methods Serum β2 MG were determined by the method of immunohistochemistry and RIA in 128 patinents with HBV infection,and expressin of β2 MG in liver was detected in 70 of 128 patients by PAP techniques of immunohistochemistry.They include asymptomatic HBsAg carriers (12patients),acute hepatitis (26),chronic hepatitis (56), severe hepatitis(18),liver biopsy.Results Serumβ2 MG level increased in acute ,chroic and severe types of viral hepatitis as well as liver cirrhosis and primary hepatic cancer with positive markers of HBV,among which the level ofβ2 MG was the highest in severe hepatitis.There were positive correlations of serumβ2 MG to hepatocytes expression as well as the level of serum bilirubin .There existed increased expressin ofβ2 MG on hepatocytes in patients with acute, chronic and severe types of hepatitis B.The positive hepatocytes ofβ2 MG expression as well largely located in the inflammatory and necrotic areas in liver tissues.Serial assays ofβ2 MG levels showed that in the convalescent phase of acute hepatits B,theβ2 MG level decreased to or near normal and the level was higher in patients with severe hepatitis who died eventually than in those who survived.Conclusion The increase ofβ2 MG can reflect the severity of liver damage in certain degree and its continuous observation would be helpful to the judgement of outcome and prognosis in acute and severe hepatitis B.The increase ofβ2 MG in viral hepatitis B may be due to the increase ofβ2 MG release from liver[