Magrin S, Craxi A, Fabiano C, Fiorentino G, Almasio P, Palazzo U, Pinzello G, Provenzano G, Pagliaro L, Choo Q L
Clinica Medica R, University of Palermo, Italy.
J Hepatol. 1991 Nov;13(3):364-7. doi: 10.1016/0168-8278(91)90082-m.
Both high and low anti-hepatitis C virus antibody (anti-HCV) prevalence has been reported in autoimmune chronic active hepatitis. Therefore, we studied 15 consecutive HBsAg-negative, ELISA anti-HCV-positive, autoantibody-positive patients with biopsy proven chronic active hepatitis in order to confirm ELISA specificity by immunoblot test (RIBA-HCV), and to evaluate HCV replication by serum HCV-RNA. Nine patients were anti-nuclear, three type 1 anti-liver-kidney microsomal and three anti-smooth muscle antibody positive. None had associated autoimmune disease. All cases showed mild clinical disease and only moderate necroinflammatory activity. Response to prednisone was poor. RIBA-HCV confirmed ELISA results in all patients. HCV-RNA was found in the serum from 10 patients. Institution of alpha-interferon treatment in three steroid non-responsive patients was followed by prompt normalization of transaminases. Thus, a subgroup of autoantibody-positive chronic active hepatitis can be recognized as HCV-related and should be clinically and etiologically distinguished from autoimmune chronic active hepatitis. Trials of alpha-interferon treatment are worthwhile in this condition.
自身免疫性慢性活动性肝炎患者中抗丙型肝炎病毒抗体（抗-HCV）的高患病率和低患病率均有报道。因此，我们对15例经活检证实为慢性活动性肝炎、连续入选的HBsAg阴性、ELISA抗-HCV阳性且自身抗体阳性的患者进行了研究，目的是通过免疫印迹试验（RIBA-HCV）确认ELISA的特异性，并通过血清HCV-RNA评估HCV复制情况。9例患者抗核抗体阳性，3例1型抗肝肾微粒体抗体阳性，3例抗平滑肌抗体阳性。均无相关自身免疫性疾病。所有病例均表现为轻度临床疾病，仅伴有中度坏死性炎症活动。对泼尼松反应不佳。RIBA-HCV在所有患者中均证实了ELISA结果。10例患者血清中检测到HCV-RNA。3例对类固醇无反应的患者接受α-干扰素治疗后转氨酶迅速恢复正常。因此，自身抗体阳性的慢性活动性肝炎亚组可被认为与HCV相关，应在临床和病因学上与自身免疫性慢性活动性肝炎相区分。在这种情况下，进行α-干扰素治疗试验是值得的。
