Wu Chi-hong, Xu Xiao-yuan, Tian Geng-shan, Yu Yan-yan
Department of Infectious Disease, Peking University First Hospital, Beijing 100034, China.
Zhonghua Yi Xue Za Zhi. 2006 Feb 14;86(6):390-3.
To investigate the serum autoantibodies in patients with chronic hepatitis C and to investigate the significance of autoimmune reaction in hepatitis C virus (HCV) infected patients.
Peripheral blood samples were collected from 69 patients with chronic hepatitis C, 69 patients with chronic hepatitis B (HB), and 69 patients with autoimmune hepatitis (AIH). Indirect immunofluorescence technique was used to detect the serum anti nuclear antibody (ANA), anti-mitochondrial antibody (AMA), anti-smooth muscle antibody (anti-SMA), and anti-liver-kidney antibody (anti-LKM). HCV RNA was detected by PCR. The biochemical indices: alanine transaminase (ALT), aspartate aminotransferase (AST), total bilirubin (TBIL), and gamma-globulin were detected. The relations of autoantibodies to virus load, HCV genotype, cirrhosis, age, sex, and liver function were analyzed.
(1) Twenty of the HCV patients were positive in autoantibodies, most being at a low titer, 11 of them being positive in ANA, 7 in anti-SMA, 1 in anti-AMA, and 1 in anti-LKM, with a positive rate of 28.9%, significantly higher than that of the HB patients (4.3%, P < 0.05), and significantly lower than that of the AIH patients (100%, P < 0.05). (2) There were no significant differences between the autoantibody positive group and autoantibody negative group in virus load and HCV genotype. (3) Fourteen of the 18 patients positive in autoantibodies responded to the anti-virus treatment with alpha-interferon with a response rate of 77.8%, significantly higher than that of the autoantibody negative group (53%, P < 0.05). (4) The average age of the autoantibody positive group was 47 +/- 18 years, significantly higher than that of the autoantibody negative group (39 +/- 12 years, P < 0.05). The positive autoantibody rate of the patients aged >or= 40 was 23.1%, significantly higher than that of the patients aged < 40 (5.8%, P < 0.05). There was no significant difference in the autoantibody rate between males and females. (5) The cirrhosis prevalence rate of the autoantibody positive group was 80%, significantly higher than that of the autoantibody negative group (46.9%, P < 0.05). (6) The serum ALT, AST, TBIL and gamma-globulin of the autoantibody positive group were 191 U/L +/- 89 U/L, 169 U/L +/- 80 U/L, 78 micromol/L +/- 50 micromol/L, and 200 g/L +/- 80 g/L respectively, all significantly higher than those of the autoantibody negative group (113 U/L +/- 69 U/L, 98 U/L +/- 62 U/L, 51 micromol/L +/- 30 micromol/L, and 160 g/L +/- 70 g/L respectively, all P < 0.05). (7) There were no significant differences in HCV RNA load and HCV genotype between the autoantibody positive group and the autoantibody negative group (both P > 0.05).
HCV infection induces the autoimmune reaction resulting in production of autoantibodies. Positive autoantibody rate is related with cirrhosis and age. Titer and type of autoantibody serve as important indices in the diagnosis and treatment of HCV.
研究慢性丙型肝炎患者血清自身抗体，探讨自身免疫反应在丙型肝炎病毒（HCV）感染患者中的意义。
收集69例慢性丙型肝炎患者、69例慢性乙型肝炎（HB）患者及69例自身免疫性肝炎（AIH）患者的外周血样本。采用间接免疫荧光技术检测血清抗核抗体（ANA）、抗线粒体抗体（AMA）、抗平滑肌抗体（抗SMA）及抗肝肾微粒体抗体（抗LKM）。采用聚合酶链反应（PCR）检测HCV RNA。检测生化指标：丙氨酸转氨酶（ALT）、天冬氨酸转氨酶（AST）、总胆红素（TBIL）及γ-球蛋白。分析自身抗体与病毒载量、HCV基因型、肝硬化、年龄、性别及肝功能的关系。
（1）20例HCV患者自身抗体阳性，多数为低滴度，其中ANA阳性11例，抗SMA阳性7例，AMA阳性1例，抗LKM阳性1例，阳性率为28.9%，显著高于HB患者（4.3%，P<0.05），显著低于AIH患者（100%，P<0.05）。（2）自身抗体阳性组与阴性组在病毒载量及HCV基因型方面无显著差异。（3）18例自身抗体阳性患者中14例对α-干扰素抗病毒治疗有效，有效率为77.8%，显著高于自身抗体阴性组（53%，P<0.05）。（4）自身抗体阳性组平均年龄为47±18岁，显著高于自身抗体阴性组（39±12岁，P<0.05）。年龄≥40岁患者自身抗体阳性率为23.1%，显著高于年龄<40岁患者（5.8%，P<0.05）。男女自身抗体阳性率无显著差异。（5）自身抗体阳性组肝硬化患病率为80%，显著高于自身抗体阴性组（46.9%，P<0.05）。（6）自身抗体阳性组血清ALT、AST、TBIL及γ-球蛋白分别为191 U/L±89 U/L、169 U/L±80 U/L、78 μmol/L±50 μmol/L及200 g/L±80 g/L，均显著高于自身抗体阴性组（分别为113 U/L±69 U/L、98 U/L±62 U/L、51 μmol/L±30 μmol/L及160 g/L±70 g/L，均P<0.05）。（7）自身抗体阳性组与阴性组HCV RNA载量及HCV基因型无显著差异（均P>0.05）。
HCV感染可诱导自身免疫反应，导致自身抗体产生。自身抗体阳性率与肝硬化及年龄有关。自身抗体的滴度及类型是HCV诊断及治疗的重要指标。
