Cassani F, Muratori L, Manotti P, Lenzi M, Fusconi M, Ballardini G, Selleri L, Volta U, Zauli D, Miniero R
Cattedra di Semeiotica, Medica II, University of Bologna, Italy.
Gut. 1992 Sep;33(9):1260-3. doi: 10.1136/gut.33.9.1260.
Antinuclear antibodies with the homogeneous pattern (ANA-H) and smooth muscle antibodies with antiactin specificity (SMA-AA) are regarded as the serum markers of type-1 autoimmune chronic hepatitis. Their diagnostic relevance, however, has been questioned recently after the detection of signs of hepatitis C virus infection in autoimmune chronic hepatitis patients. To further evaluate this point, antihepatitis C virus antibodies were sought by two second generation assays (ELISA 2 and RIBA 2) in 100 Italian patients with chronic liver disease of unknown aetiology, including 46 with (autoimmune chronic hepatitis) and 54 without the above antibodies (cryptogenic). By ELISA 2, antihepatitis C virus, although significantly prevalent in cryptogenic (83%), were found also in a substantial proportion of autoimmune chronic hepatitis patients (46%) (p < 0.0001), their occurrence was confirmed by RIBA 2 in almost all cases (96% and 86%, respectively). Autoimmune patients with either ANA-H or SMA-AA exhibited similar antihepatitis C virus prevalences (59% and 52%, respectively); by contrast, the eight cases positive for both the autoantibodies were consistently antihepatitis C virus negative. These findings confirm that in countries with high hepatitis C virus circulation (like Italy) an overlap between autoimmune chronic hepatitis and hepatitis C virus infection, reflected by 'true' antihepatitis C virus antibodies, does occur. The detection of ANA-H or SMA-AA, in fact, identifies chronic liver disease patients with a relatively low prevalence of antihepatitis C virus, but does not exclude hepatitis C virus infection. Positive findings for both ANA-H and SMA-AA, however, is an appropriate marker for hepatitis C virus free 'primary' autoimmune chronic hepatitis.
均质型抗核抗体（ANA-H）和抗肌动蛋白特异性平滑肌抗体（SMA-AA）被视为1型自身免疫性慢性肝炎的血清标志物。然而，在自身免疫性慢性肝炎患者中检测到丙型肝炎病毒感染迹象后，它们的诊断相关性最近受到了质疑。为了进一步评估这一点，采用两种第二代检测方法（ELISA 2和RIBA 2）对100例病因不明的意大利慢性肝病患者进行了抗丙型肝炎病毒抗体检测，其中包括46例有上述抗体的患者（自身免疫性慢性肝炎）和54例无上述抗体的患者（隐源性肝炎）。通过ELISA 2检测发现，抗丙型肝炎病毒抗体虽然在隐源性肝炎患者中显著常见（83%），但在相当比例的自身免疫性慢性肝炎患者中也有发现（46%）（p<0.0001），几乎所有病例通过RIBA 2检测都证实了其存在（分别为96%和86%）。ANA-H或SMA-AA阳性的自身免疫性患者抗丙型肝炎病毒抗体的流行率相似（分别为59%和52%）；相比之下，两种自身抗体均为阳性的8例患者丙型肝炎病毒抗体始终为阴性。这些发现证实，在丙型肝炎病毒高流行的国家（如意大利），自身免疫性慢性肝炎和丙型肝炎病毒感染之间确实存在重叠，表现为“真正的”抗丙型肝炎病毒抗体。事实上，ANA-H或SMA-AA的检测可识别抗丙型肝炎病毒流行率相对较低的慢性肝病患者，但不能排除丙型肝炎病毒感染。然而，ANA-H和SMA-AA均为阳性结果是无丙型肝炎病毒的“原发性”自身免疫性慢性肝炎的合适标志物。
