慢性丙型肝炎病毒感染者血清自身抗体检测的临床研究

Clinical study on serum autoantibodies of patients with chronic hepatitis C

目的 观察丙型肝炎病毒感染者血清中自身抗体的检测结果,探讨自身免疫在丙型肝炎病毒感染中的意义.方法 采用回顾性分析方法,对226例慢性丙型肝炎病毒感染者和137例慢性乙型肝炎患者血清进行ANA、anti-AMA、anti-Ro-52等自身抗体的检测,并探讨HCV-RNA含量、生化指标、年龄及性别、干扰素治疗后应答等与自身抗体变化的关系.结果 丙型肝炎感染者226例中有78例出现自身抗体阳性,检出率为34.5%（78/226）;明显高于慢性乙肝组的7.3%（10/137）（χ^2=34.396,P＜0.05）,其中ANA阳性69例,占30.5%.抗核抗体以低滴度为主.另外还检测到anti-AMA、anti-Ro-52等自身抗体;150例丙肝病毒复制指标HCV-RNA（＋）的患者,自身抗体检出率为40.7%,76例丙肝病毒复制指标HCV-RNA（-）的患者,自身抗体检出率为22.4%,两者总检出率差别有统计学意义（χ^2=7.473,P＜0.05）;自身抗体阴性、阳性者之间ALT、AST、TBIL数值分别为（65.1±24.4）U/L、（47.4±22.7）U/L、（17.2±8.2）μmol/L和（132.2±49.3）U/L、（100.7±35.2）U/L、（35.5±14.7）μmol/L,差异有统计学意义（t值分别为16.012,14.843,和9.000,均P＜0.05）;丙型肝炎自身抗体的检出率与年龄有关,而与性别无关;丙型肝炎患者经干扰素抗病毒治疗后,虽然自身抗体阳性组干扰素应答率73.9%（17/23）高于自身抗体阴性组的54.2%（26/48）,但差异无统计学意义（χ2=0.975,P＞0.05）.结论 丙型肝炎病毒感染可诱发机体自身免疫反应,产生多种自身抗体,尤其HCV-RNA阳性患者更为突出,自身抗体检出率与年龄明显有关,检测自身抗体对丙型肝炎的诊断治疗具有指导意义.

Objective This study aimed to detect serum autoantibodies of patients with chronic hepatitis C, and to explore the significance of autoimmunity in HCV infection. Methods We detected the autoantibodies, including ANA, anti-AMA, anti-Ro-52, of chronic hepatitis C patients （ n = 226） and chronic hepatitis B patients （n = 137 ）retrospectively, and explored the relationship between the variation of autoantibodies and the HCV-RNA levels, biochemistry markers, age, gender, responses after interferon treatment. Results 34. 5% （ 78/226 ） and 7.3% （ 10/137 ） were respectively autoantibodies positive in patients with chronic hepatitis C and in patients with chronic hepatitis B （χ^2 = 34. 396, P 〈 0.05 ）, and 30. 5% （69/226） of cases were ANA positive, otherwise,anti-ANA and anti-Ro-52 also weie detected. The isolating rate of autoantibodies was 40.7% in 150 patients with positive HCV-RNA ,comparatively, that rate was only 22. 4% in 76 negative HCV-RNA cases. The difference between the two groups was statistically significant（χ^2 = 7.473, P〈0.05）; The levels of ALT, AST, TBIL of negative autoantibodies cases and positive cases were （65.1±24.4 ） U/L, （47.4 ± 22.7 ） U/L, （ 17. 2 ± 8. 2 ） μ mol/L and （ 132.2 ± 49.3 ）U/L, （ 100.7 ± 35.2 ） U/L, （ 35.5 ± 14.7 ） μ mol/L, respectively. The difference between the two groups is statistically significant （ t value was 16.012,14. 843 and 9. 000 respectively, overall P 〈 0. 05 ）; The isolating rate of autoantibodies in patients with hepatitis C was related with age, and not related with gender; the response rate of interferon treatment was 73.9% in patients with positive autoantibodies, and was higher than 54. 2% in patients without autoantibodies,but the difference was not statistically significant（χ^2 = 0. 975, P 〉0.05）. Conclusions HCV infection can induce autoimmune reaction to produce sevaral autoantibodies,especially in cases with positive HCV-RNA. The isolating rate of autoantibodies is highly related with age, it can be used for the diagnosis and treatment of hepatitis C to detect autoantibodies.