183例肝炎病毒血清学标志阴性的肝病病因分析

Etiological study on seronegative hepatitis virus with 183 liver disease patients

目的了解肝炎病毒血清学标志阴性的肝病存在情况,探讨其病因。方法选择甲、乙、丙、丁、戊型病毒性肝炎血清学标志阴性血清183例。对临床上诊断为病因不明的肝病血清分别用巢式PCR(nPCR)方法和RT-PCR方法检测HBVDNA和HCVRNA,用间接免疫荧光法检测病因不明的肝病血清自身抗体,用ELISA法检测病因不明的肝病血清抗-EBV/CMVIgM抗体。结果183例肝炎病毒血清学标志阴性的肝病患者中69例是病因不明的肝病。27例是自身免疫性疾病,23例是酒精性肝病,21例是药物性肝病,24例是肝胆外科疾病,4例是非酒精性脂肪肝,2例是传染性单核细胞增多症,13例是其他疾病引起肝功能异常。病因不明的肝病是以成人为主,其血清HBVDNA和HCVRNA均为阴性。在病因不明的69例肝病患者中,7例患者1种以上自身抗体滴度为1∶320。结论在肝炎病毒血清学标志阴性的183例肝病中,病因不明的肝病、自身免疫性肝病、酒精性肝病、药物性肝病、肝胆外科疾病、非酒精性脂肪肝、传染性单核细胞增多症和其他疾病引起肝功能异常分别占37.7%、14.8%、12.6%、11.5%、13.1%、2.2%、1.1%和7.1%。血清学和核酸检测结果提示病因不明的肝病患者未感染已知肝炎病毒如HBV、HCV。对病因不明的肝病有必要检测自身抗体,以排除自身免疫性肝病。

[Objective] To learn the condition of patients with seronegative liver disease, and to discuss the etiological pattern of these liver diseases. [Methods] 183 patients with seronegative viral hepatitis in serum were selected. Utilizing of Indirect Immuno Fluorescent assay to detect the autoantibodies including ANA, AMA, SMA et al in serum of patients with unknown etiology. The technique of nest PCR was used to detect HBV DNA and RT-PCR was used to detect HCV RNA in serum of patients got liver disesase with unknown etiology. Anti-EBV/CMV IgM antibodies was measured with ELISA in serum of patients with unknown etiology. [Results] Of all 183 patients, 69 cases got liver disease with unknown etiology and 59 cases got viral hepatitis of unknown virus. These patients were primarily adults. It was found that Autoimmune Liver Disease, Alcoholic Liver Disease, Drugy Liver Disease, Hepatobiliary Surgery Disease, Non-Alcoholic Fatty Liver Disease, Infectious Monocytosis were 27, 23, 21, 24, 4, 2 cases respectively. 13 cases were those had abnormal liver functions but got non-liver disease. Among 69 patients got liver disease with unknown etiology, 7 cases indicated autoantibody positive, the titer was 1：320. [ Conclusions] Among these patients with seronegative viral hepatitis in serum, about 37.7% patients were diagnosed as viral hepatitis or liver cirrhosis without knowing of aetiology and these patients can not probably infected by currently known hepatitis vires. About 14.8% eases were diagnosed as autoimmune liver disease. It is necessary that autoantibodies should be examined on patients with hepatitis with unknown aetiology for differential diagnosis of autoimmune liver disease.