Czaja A J, Taswell H F, Rakela J, Schimek C M
Division of Gastroenterology, Mayo Clinic, Rochester, MN 55905.
Mayo Clin Proc. 1990 Oct;65(10):1303-13. doi: 10.1016/s0025-6196(12)62141-7.
To determine the frequency and significance of antibody to hepatitis C virus (anti-HCV) in severe cryptogenic chronic active hepatitis (CAH), we tested sera from 17 corticosteroid-treated patients by an enzyme immunoassay. Specificity of the antibodies to HCV-encoded antigens was assessed by recombinant immunoblot assay. The findings in patients with and without anti-HCV were contrasted, and the frequency of seropositivity was compared with that in patients who had other types of chronic liver disease and in normal adults. Only three patients (18%) with severe cryptogenic CAH had anti-HCV. Sera from two of these patients were reactive by recombinant immunoblot assay; the other sample produced an indeterminate reaction. The frequency of seropositivity in patients with cryptogenic disease was not statistically different from that in patients with autoimmune CAH (6%), hepatitis B surface antigen-positive CAH (9%), or alcoholic liver disease (0%), but it was significantly less than in those with posttransfusion CAH (18% versus 75%; P less than 0.01). Seropositive patients tended to have lower serum aspartate aminotransferase, gamma-globulin, and bilirubin levels than seronegative counterparts, and they did not have histologic features of confluent necrosis at initial assessment. Two of the three seropositive patients, both of whom had been reactive by recombinant immunoblot assay, entered remission during therapy, and one, with an indeterminate reaction, died of liver failure. We conclude that anti-HCV occurs infrequently in severe corticosteroid-treated cryptogenic CAH. Seropositive patients may have less severe inflammatory activity than seronegative counterparts. Cryptogenic disease may improve during corticosteroid treatment, a result suggesting an underlying immunologic disorder in some patients.
为了确定严重原因不明的慢性活动性肝炎（CAH）中丙型肝炎病毒抗体（抗-HCV）的频率及意义，我们采用酶免疫分析法检测了17例接受皮质类固醇治疗患者的血清。通过重组免疫印迹法评估针对丙型肝炎病毒编码抗原的抗体的特异性。对比了抗-HCV阳性和阴性患者的检查结果，并将血清阳性率与患有其他类型慢性肝病的患者及正常成年人的血清阳性率进行了比较。仅有3例（18%）严重原因不明的CAH患者存在抗-HCV。其中2例患者的血清经重组免疫印迹法检测呈阳性反应；另一份样本产生了不确定反应。原因不明疾病患者的血清阳性率与自身免疫性CAH患者（6%）、乙肝表面抗原阳性的CAH患者（9%）或酒精性肝病患者（0%）相比，在统计学上无差异，但显著低于输血后CAH患者（18%对75%；P<0.01）。血清阳性患者的血清天冬氨酸转氨酶、γ-球蛋白和胆红素水平往往低于血清阴性患者，且在初始评估时他们没有融合性坏死的组织学特征。3例血清阳性患者中有2例，其血清经重组免疫印迹法检测均呈阳性反应，在治疗期间病情缓解，而另1例反应不确定的患者死于肝功能衰竭。我们得出结论，在接受皮质类固醇治疗的严重原因不明的CAH患者中，抗-HCV发生率较低。血清阳性患者的炎症活动可能不如血清阴性患者严重。皮质类固醇治疗期间原因不明的疾病可能会改善，这一结果提示部分患者存在潜在的免疫紊乱。
