丙型肝炎病毒感染患者血清肝特异性自身抗体的检测及临床研究

Identification and Clinical Significance of Liver Specific Autoantibodies in Patients With Hepatitis C

目的了解丙型肝炎患者血清中肝特异性自身免疫性抗体的检出率,探讨自身免疫在丙型肝炎(HCV)感染中的意义。方法采用间接免疫荧光法,对220例丙型肝炎病毒感染者血清进行肝特异性自身抗体的检测;应用聚合酶链反应定量检测血清HCV-RNA含量,HCV抗体的检测用ELISA法;回顾性分析HCV-RNA病毒、AST、ALT、ALP和r-GT与自身抗体检出的关系。结果220例丙型肝炎患者总自身抗体检出率为32.73%;HCV-IgG单阳性(HCV-IgG(+)HCV-RNA(-))的检出率为29.57%;HCV-IgG(+)HCV-RNA(+)自身抗体检出率为40.59%,HCV-IgG(+)HCV-RNA(-)与HCV-IgG(+)HCV-RNA(+)组比较差异有统计学意义(P<0.01)。各组与正常对照比较差异均有统计学意义(P<0.01);自身抗体以低滴度为主,主要为抗核抗体。自身阳性的检出与性别无关(P>0.05)与年龄关系密切(P<0.01)。自身抗体阳性丙型肝炎患者的血清丙氨酸氨基转移酶(ALT)、谷氨酸氨基转移酶(AST)、碱性磷酸酶(ALP)及γ-球蛋白均高于自身抗体阴性患者,差异有统计学意义(P<0.01)。结论HCV在感染过程中可诱导自身免疫反应,使感染者体内产生多种自身抗体,自身抗体检出率与年龄关系密切且与病毒的复制有关。自身抗体以低滴度为主,主要为抗核抗体。自身抗体可能是HCV感染后肝组织损伤的重要因素,应引起重视。

Objective To study the incidence of serum liver specific autoantibodies and the significance of autoimmunity in hepatitis C virus （HCV） infected patients. Methods A total of 220 patients with Hepatitis C were analyzed in the study, their serum liver specific autoantibodies were identified by indirect immunofluorescence assay, HCV- DNA was determined by realtime quantitative PCR and anti - HCV was measured with ELISA. The relations between autoantibodies and the bio- chemical indices including ALT, AST, ALP and y - globulin were analyzed retrospectively. Results The positive rate of autoantibodies in the 220 Hepatitis C patients was 32. 7 %. Patients with only anti - HCV IgG （ ＋ ） showed 29. ？5 % autoantibodies positive, while those with both anti- HCV IgG（ ＋ ） and HCV- RNA （ ＋ ） showed 40.59% autoantibodies positive,the difference was statistical significant （P〈 0.01 ） ; and both groups were significantly different with the healthy control group （P 〈 0.01 ）. The titer of autoantibodies presented in Hepatitis C patients was in low levels, and most of them were anti- nuclear antibodies. Autoantibodies were significantly associated with age （P〈 0.01 ）, but not with genders （ P 〉 0.05）. The serum ALT, AST, ALP and γ - globulin of the autoantibody positive group were all significantly higher than those of the autoantibody negative group respectively （P〈 0.01 ）. Conclusions The results suggest that autoimmune reaction and the presence of ANA might be the important factors in hepatic tissue injury in patients with hepatitis C.