乙型肝炎的自身抗体检测分析及临床意义

Detection and its clinical significance of hepatitis B autoantibody

目的:检测乙型肝炎自身抗体的阳性率,探讨乙型肝炎自身抗体存在的临床意义。方法:分别采用间接免疫荧光法(IIF)和免疫印迹法(Western-blot)检测453例乙型肝炎、162例自身免疫性肝炎(AIH)和96例正常人抗核抗体(ANA)的阳性率、ANA阳性滴度、核型和抗双链DNA抗体(dsDNA)的阳性率以及肝炎相关自身抗体:抗平滑肌抗体(SMA)、抗肝肾微粒体抗体(LKM)的阳性率。应用酶法检测患者的ALT和AST,实时荧光定量PCR技术检测HBV DNA。结果:①乙肝组ANA的阳性率为22.7%,ANA以低滴度(1∶100)为主,仅3例乙肝后肝硬化的滴度为1∶320;ANA核型以均质型为主,仅5例为斑点型,显著低于AIH组(P<0.01)。其中急性乙肝、慢性乙肝、重症乙肝和乙肝后肝硬化ANA的阳性率分别为5.2%、22.8%、24.2%和37.9%,慢性乙肝、重症乙肝和乙肝后肝硬化患者ANA的阳性率显著高于急性乙肝(P<0.05或P<0.01),乙肝后肝硬化组明显高于乙肝炎组(P<0.05或P<0.01)。②ANA阳性乙肝患者伴有dsDNA抗体,用Western-blot法检测dsDNA的阳性率为10.34%,显著高于ANA阴性的乙肝患者(P<0.05),乙肝组dsDNA的阳性率为2.42%与AIH组差异无统计学意义(P>0.05)。③乙型肝炎存在SMA和LKM,但仅有较低的阳性率分别为4.63%和3.31%,显著低于AIH组(P<0.01)。④乙型肝炎ANA阳性组的ALT、AST水平和HBV DNA阳性率显著高于ANA阴性组(P<0.05);乙肝组ALT、AST水平和HBV DNA阳性率显著高于AIH组(P<0.01)。结论:HBV感染不仅引起肝组织损害,还诱导产生多种以低滴度为主的自身抗体。自身抗体的产生与肝损伤程度有一定相关性,并与HBV复制水平相关;其在探讨乙肝发生、发展机制和病因研究中有一定的意义。

Objective：To detect hepatitis B autoantibody in patients with autoimmune hepatitis （AIH）, and investigate the clinical significance of hepatitis B autoantibody presence. Method： Serum ANA, SMA and LKM, dsDNA, ALT and AST and HBVDNA of 453 patients with hepatitis B, 162 AIH patients and 96 controls were detected by indirect immnuofluoreseence （IIF）, Western-blot, kinetic enzymatic method, and real-time fluorescence quantitative PCR, respectively. Result：The positive rate of ANA by IIF in hepatitis B patients was 22.7%, which was significantly lower than that in AIH group（ P 〈0. 01）. ANA titer of most patients with hepatitis B was 1 ： 100, with homogeneous type. The positive rate of ANA in patients with acute1 hepatitis B, chronic Hepatitis B, severe hepatitis B and hepatitis B liver cirrhosis were 5.2%, 22.8%, 24.2% and 37.9%, respectively. The positive rates of ANA in patients with chronic hepatitis B , severe hepatitis B and hepatitis B liver cirrhosis were significantly higher than that in patients with acute1 hepatitis B （ P 〈0.05 or P 〈0.01）. The positive rate of ANA in patients with hepatitis B liver cirrhosis was significantly higher than that in patients with hepatitis B（ P 〈0.05 or P 〈0. 01）. The positive rate of dsDNA in hepatitis B patients with ANA（＋） was 10. 34 %, which was significantly higher than that in patients with ANA（-）. The positive rate of dsDNA in patients with hepatitis B was 2.42%, The was no significant difference between patients with hepatitis B and AIH. The positive rates of SMA and LKM in hepatitis B patients were 4.63% and 3.31%, repectively, which were significantly lower than those in AIH patients. The positive rates of ALT, AST and HBVDNA in Hepatitis B patients with ANA（＋） were sig-nificantly higher than those in the group of patients with ANA（-）. The positive rates of ALT, AST and HBVD- NA in hepatitis B patients were significantly higher than those in AIH patients. Conclusion： HBV infection not only can cause liver tissue damage,hut also can induce to produce a variety of low-titer autoantibodies. Autoantihody production has a certain correlation with liver injury and the level of HBV replication, and may play a certain role in the pathogenesis and etiological study of hepatitis B.