血吸虫病患者肝纤维化与ANCA的相关性分析

Correlation between hepatic fibrosis and anti-neutrophil cytoplasmic antibodies (ANCA) in schistosomiasis patients

目的研究血吸虫病患者肝纤维化与抗中性粒细胞胞质抗体(ANCA)的关系。方法随机选取2014年2月至2016年6月期间荆州市第一人民医院确诊的血吸虫病患者145例作为病例组,随机选取同期在该院体检的健康体检者100例作为对照组,采集两组血清,通过间接免疫荧光法检测ANCA,以放射免疫法检测透明质酸、层粘蛋白、Ⅲ型前胶原和Ⅳ型胶原,比较两组上述指标的水平。结果病例组ANCA阳性率为28.96%(42/145),对照组为1.00%(1/100),差异有统计学意义(P<0.05)。病例组透明质酸、层粘蛋白、Ⅲ型前胶原和Ⅳ型胶原水平均高于对照组,4项肝纤维化指标水平异常者所占比例亦高于对照组,差异均有统计学意义(P均<0.05)。病例组中,42例ANCA阳性者中透明质酸、层粘蛋白水平异常者所占比例均高于ANCA阴性者;前者4项肝纤维化指标均值均高于相应正常参考值,其透明质酸、层粘蛋白水平平均值显著高于ANCA阴性者,差异均有统计学意义(P<0.05)。结论血吸虫病肝纤维化患者可出现自身免疫性抗体ANCA阳性,ANCA可能与肝纤维化的自身免疫过程有关。

Objective To investigate the association between hepatic fibrosis and anti-neutrophil cytoplasmic antibodies （ANCA）in the patients with schistosomiasis. Methods Totally 145 schistosomiasis patients confirmed by Jingzhou First Peo-ple＆#39;s Hospital during the period of February 2014 to June 2016 were randomly selected as an experimental group,and 100 healthy people during the same period were randomly selected as a control group. The serum samples of the two groups were col-lected and the level of ANCA was detected by indirect immunofluorescence,and the levels of hyaluronic acid,laminin,procol-lagen type Ⅲ,and collagen type Ⅳ were detected by radioimmunoassay. The levels of the above indexes of the two groups were compared. Results The positive rate of ANCA was 28.96%（42/145）in the experimental group and 1.00%（1/100）in the healthy control group,and the difference between them was statistically significant（P 〈 0.05）. The levels of hyaluronic acid, laminin,procollagen type Ⅲ and collagen type Ⅳ in the experimental group were significantly higher than those in the control group,and the differences were statistically significant（all P 〈 0.05）,and the proportions of those with abnormal levels of hyal-uronic acid,laminin,procollagen type Ⅲ and collagen type IV in the experimental group were significantly higher than those in the control group,and the differences were statistically significant（all P 〈 0.05）. In the experimental group,among the 42 pa-tients with ANCA positives,the proportions of those with abnormal levels of hyaluronic acid and laminin were significantly high-er than the proportions of those with ANCA negatives,and in the former,the levels of the four indicators of liver fibrosis were all higher than the normal values,and the average levels of hyaluronic acid and laminin in the patients with ANCA positives were significantly higher than those in the patients with ANCA negatives（all P 〈 0.05）. Conclusion The patients with schistosomia-sis hepatic fibrosis could be positive for the autoimmune antibody ANCA,and ANCA may be associated with the autoimmune process of liver fibrosis.