Ortarık Zehra, Toyran Alparslan, Sen Sevinç, Mart Kömürcü Selen Z, Güvener Engin
Ankara Numune Training and Research Hospital, 1st Microbiology and Clinical Microbiology Laboratory, Ankara, Turkey.
Mikrobiyol Bul. 2011 Apr;45(2):296-305.
The prediction of development of hepatic fibrosis is of crucial importance in terms of disease monitorization and treatment follow-up of patients with chronic hepatitis C virus (HCV) infections. Liver biopsy which is an invasive and complicated method, still remains as the gold standard method for the diagnosis of liver fibrosis. Recently, non-invasive diagnostic tests to determine the biological markers of liver fibrosis have been developed as a possible alternative to liver biopsy. The aim of this study was to evaluate the levels of serum IgG, IgA and IgM antibodies as possible indicators for hepatic fibrosis among patients with chronic HCV infection. A total of 57 patients (35 female, 22 male; mean age: 51 ± 8.9 years) who were followed-up between January 2007-November 2008, were enrolled in the study. All of the patients were positive for serum anti-HCV and HCV-RNA, while none of them were under antiviral therapy for the last six months. The patients were hospitalized for liver biopsy and biopsy samples were evaluated according to Modified Knodell Histological Activity Index. Forty-nine patients with no liver fibrosis or low to moderate fibrosis were classified as Group 1 (stage 0, 1, 2, 3) and eight patients with high to severe fibrosis were classified as Group 2 (stage 4, 5, 6). Serum IgG, IgA and IgM levels of the patients were determined by a commercial immunonephelometric method (Dade Behring, Germany). Increased antibody levels were detected in a total of 61.4% (35/57) of patients, of which 28 (49.1%) yielded high IgG, 5 (8.8%) yielded high IgM and 2 (3.5%) yielded high IgA levels. The mean IgG levels of patients in Group 1 and 2 were 16.3 ± 4.6 and 21.8 ± 5.2 g/L; mean IgM levels were 1.3 ± 0.6 and 1.6 ± 0.8, and median IgA levels were 2.0 (0.5-5.3) and 3.3 (1.3- 4.3) g/L, respectively. IgG and IgA levels of patients from Group 2 were found significantly higher than those patients from Group 1 (p= 0.003, p= 0.03, respectively), however there was no significant difference between the groups with respect to serum IgM levels (p= 0.311). When the patient groups were also evaluated in terms of other parameters, no statistically significant differences were detected for ALT, AST, HCV-RNA levels and mean ages (p= 0.95, p= 0.21, p= 0.73, p= 0.10, respectively), however, anti-HCV levels were found significantly higher in Group 2 (p= 0.043). The data of this study indicated a significant relationship between the levels of serum IgG, IgA and the severity of hepatic fibrosis among patients with chronic HCV infection. It was concluded that high serum IgG and IgA levels may be helpful indicators together with the other non-invasive markers for the prediction of liver fibrosis in case when liver biopsy could not be performed.
对于丙型肝炎病毒（HCV）慢性感染患者的疾病监测和治疗随访而言，肝纤维化发展的预测至关重要。肝活检作为一种侵入性且复杂的方法，仍是肝纤维化诊断的金标准方法。近来，已开发出用于确定肝纤维化生物标志物的非侵入性诊断测试，作为肝活检的一种可能替代方法。本研究的目的是评估血清IgG、IgA和IgM抗体水平，作为慢性HCV感染患者肝纤维化的可能指标。共有57例患者（35例女性，22例男性；平均年龄：51±8.9岁）纳入本研究，这些患者于2007年1月至2008年11月期间接受随访。所有患者血清抗HCV和HCV-RNA均为阳性，且在过去六个月内均未接受抗病毒治疗。患者住院接受肝活检，并根据改良的Knodell组织学活动指数对活检样本进行评估。49例无肝纤维化或低至中度纤维化的患者被归类为第1组（0、1、2、3期），8例高至重度纤维化的患者被归类为第2组（4、5、6期）。采用商用免疫比浊法（德国达德拜耳公司）测定患者的血清IgG、IgA和IgM水平。总共61.4%（35/57）的患者检测到抗体水平升高，其中28例（49.1%）IgG水平升高，5例（8.8%）IgM水平升高，2例（3.5%）IgA水平升高。第1组和第2组患者的平均IgG水平分别为16.3±4.6和21.8±5.2 g/L；平均IgM水平分别为1.3±0.6和1.6±0.8，IgA水平中位数分别为2.0（0.5 - 5.3）和3.3（1.3 - 4.3）g/L。发现第2组患者的IgG和IgA水平显著高于第1组患者（分别为p = 0.003，p = 0.03），然而两组患者的血清IgM水平无显著差异（p = 0.311）。当根据其他参数对患者组进行评估时，未检测到ALT、AST、HCV-RNA水平和平均年龄有统计学显著差异（分别为p = 0.95，p = 0.21，p = 0.73，p = 0.10），然而，第2组患者的抗HCV水平显著更高（p = 0.043）。本研究数据表明，慢性HCV感染患者血清IgG、IgA水平与肝纤维化严重程度之间存在显著关系。得出的结论是，在无法进行肝活检的情况下，高血清IgG和IgA水平可能与其他非侵入性标志物一起，有助于预测肝纤维化。
