Magrin S, Craxì A, Fiorentino G, Fabiano C, Provenzano G, Pinzello G B, Palazzo U, Almasio P, Pagliaro L
Clinica Medica R, University of Palermo, Italy.
J Hepatol. 1991 Jul;13(1):56-60. doi: 10.1016/0168-8278(91)90864-8.
We evaluated the specificity and clinical relevance of anti-hepatitis C virus antibody positivity in 22 HBsAg-negative patients with autoimmune (anti-nuclear, anti-actin or anti-liver-kidney microsomal antibody positive) chronic active hepatitis. An ELISA anti-HCV test and a recombinant immunoblot assay (RIBA-HCV) were used. Thirteen patients (59%) were anti-HCV positive and five (23%) anti-HCV negative by both ELISA and RIBA-HCV tests. Four patients (18%) were borderline positive by ELISA (OD less than 1.0), and three of them (all with severe disease) were negative by RIBA. Histologic necroinflammation, AST/ALT and gamma-globulins levels were higher and response to prednisolone treatment was better in RIBA anti-HCV-negative than in anti-HCV-positive cases. We confirmed with both RIBA and ELISA tests the high prevalence of anti-HCV already reported by ELISA in anti-nuclear and anti-liver-kidney microsomal antibody positive chronic active hepatitis. False positive for anti-HCV (i.e., a positive ELISA test not confirmed by RIBA) occurred only among patients with severe disease. Since RIBA-negative subjects showed the best response to corticosteroid, they might represent the only subset of cases of 'true' autoimmune chronic active hepatitis.
我们评估了22例HBsAg阴性、自身免疫性（抗核抗体、抗肌动蛋白抗体或抗肝肾微粒体抗体阳性）慢性活动性肝炎患者中抗丙型肝炎病毒抗体阳性的特异性及临床相关性。采用了ELISA抗-HCV检测和重组免疫印迹法（RIBA-HCV）。13例患者（59%）ELISA和RIBA-HCV检测均为抗-HCV阳性，5例患者（23%）均为抗-HCV阴性。4例患者（18%）ELISA检测为临界阳性（OD值小于1.0），其中3例（均为重症患者）RIBA检测为阴性。与抗-HCV阳性病例相比，RIBA抗-HCV阴性病例的组织学坏死炎症、AST/ALT及γ-球蛋白水平更高，对泼尼松龙治疗的反应更好。我们通过RIBA和ELISA检测均证实了ELISA已报道的抗核抗体和抗肝肾微粒体抗体阳性慢性活动性肝炎中抗-HCV的高流行率。抗-HCV假阳性（即ELISA检测阳性但RIBA未证实）仅出现在重症患者中。由于RIBA阴性患者对皮质类固醇治疗反应最佳，他们可能代表了“真正的”自身免疫性慢性活动性肝炎的唯一病例亚组。
