乙型肝炎患者血清抗核抗体的检测及临床意义探讨

Expression analysis and clinical significance of serum anti-nuclear antibodies in hepatitis B patients

目的检测乙型肝炎患者血清中抗核抗体(ANA)的阳性率,并分析其与性别、年龄及病情转归之间的相关性,探讨其潜在的临床应用价值。方法选用196例乙型患者为实验组,110例健康体检者为对照组,分别对其血清采用间接免疫荧光法(IIF)检测ANA;实时荧光定量PCR法检测HBV-DNA含量;OLYMPUS AU640全自动生化分析仪检测ALT、AST,并对其结果进行统计学分析。结果 196例HBV乙肝患者中ANA阳性率为31.6%,明显高于正常对照组(4.5%),并且以低滴度为主,占62.9%,荧光模式以颗粒型和均质型为主;ANA阳性的女性多于男性,年龄以中年居多;ANA阳性率随着HBV-DNA含量的升高而升高;ANA阳性组的ALT、AST显著高于ANA阴性组(P<0.05)。结论 HBV感染可导致自身免疫的发生并以低滴度为主;ANA的检出率与性别,年龄及病情的转归有一定的相关性,为了解乙肝患者机体的免疫状况,临床对肝炎做出鉴别诊断,指导临床合理用药提供帮助。

To determine the expression of anti-nuclear antibodies （ANA） in the hepatitis B patients, analyze its association with gender, age and the prognosis of hepatitis, and explore its clinical application, total of 196 cases ofhepatitis B patients were selected as experimental group and 110 healthy individuals as control group. The indirect immunofluorescence method （IIF） was applied for the detection of ANA in serum; real-time quantitative PCR wasperformed for HBV-DNA measurement; and OLYMPUS AU640 automatic biochemical analyzer was used to detect the serum levels of ALT and AST. Among these hepatitis B patients, the positive rate of ANA was 31.6%,significantly higher than that in the normal control group （4.5%）. ANA positive hepatitis B patients were mainly characterized with low titers of ANA （62.9%） and showed speckled and homogeneous fluorescence pattern. Amonghepatitis B patients, women were more commonly ANA positive than men （P 〈 0.05）, and the majority of ANA positive hepatitis B patients were middle-aged. There is a significant association between the positive rate of ANAand the level of HBV-DNA virus. The concentrations of ALT and AST in ANA positive group were significantly higher than the corresponding ones in ANA negative group （both P〈 0.05）. In summary, HBV infection can lead toautoimmune response characterized with low-titer ANA. The presence of ANA is significantly associated with gender, age, and even the disease progression of hepatitis. Thus, ANA analysis might help evaluate the immunestatus of hepatitis B patients and possibly assist clinical diagnosis and drug guidance.