各型HBV感染者血清和肝细胞β2微球蛋白的意义

Clinical significance of serum and liver β2 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，研究其临床意义方法HBV感染者128例中，无症状携带着（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。设正常对照30例，用RIA和免疫级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。

AIM To demonstrate the clinical significance of β2microglobulin (β2MG) and its role in pathogenesis in various types of bepetitis B virus infecion.METHODS berum β2 MG were determined by the method of PEG RIA in 128 patients with HBV inthetion, and expression of β2 MG in liver was detected in 70 of 128 patients by PAP thehniques of imunohistochemistry.They include asymptomatic HBsAg carriers(12 petients),acute hepetitis (26), chronic hepetitis (56), severe hepaitis (18), liver cirrhosis (8) and primary hepetic cancer (8 ). Seventy patients were diagned by pathology through liver biopsy.RESULTS Serum & MG level was increaed in acute,chrooic and severe types of viral hepetitis as well as liver cirrhosis and primary hepetic cancer with positive markers of HBV, among which the level ofβ2 MG was the highest in severe hepatitis. There were positive correlations of serum β2 MG to hepatocytes expression as well as th6 level of serum bilirubin. There existed increaed expression of β2 MG on bepetocytes in patients with acute, chronic and severe types of hepatitis B. The positive hepatocytes of β2 MG xpression were largely located in the inflammatory and necrotic areas in liver tissues. Serial assays of β2 MG levels showed that in the convalescent phase of acute hepetitis B, the β2 MG level decreaed to or near normal. And the level was higher in petients with severe hepetitis who died eventually than in those who survived.CONCLUSION The increase of β2 MG can reflect in certain degree the severity of liver damage and its continuoos bervation would be bolpful to the judgement of outcome and prognosis in acute and severe hepatitis B.The mechanism of β2 MG increase in viral hepatitis B may be contributed to the increase of β2 MG release from liver.