Endemic Medicine and Hepatology Unit, Faculty of Medicine, Cairo University, Cairo, Egypt.
Liver Int. 2013 Nov;33(10):1504-9. doi: 10.1111/liv.12227. Epub 2013 Jun 14.
BACKGROUND & AIMS: Prevalence of serum autoantibodies in chronic hepatitis C (HCV) patients is higher than that in the general population. Interferon may induce autoimmune manifestations in patients treated with peg-interferon and ribavirin. Effect of autoantibody seropositivity and treatment response are limited and controversial. To detect the prevalence of serum autoantibodies in patients with chronic HCV and impact on histopathology and treatment response.
Retrospective study including 3673 Egyptian chronic HCV naïve patients enrolled in the Egyptian national programme for HCV treatment with pegylated interferon and ribavirin in the years 2007-2010. Antinuclear antibody (ANA) was determined by ELISA considered positive with a titre ≥ 1:40 by indirect immunofluorescence. ANA-positive patients pre treatment workup including serum aminotransferases, thyroid profile and liver biopsy, follow-up during treatment and sustained virological response (SVR) were assessed compared to ANA-negative patients.
Serum ANA was positive in 1.6% of the studied patients. There were no statistically significant differences concerning the demographic, biochemical and histopathological data in ANA positive and negative patients. SVR was comparable between ANA-positive and ANA-negative patients (67.8% and 61.3% respectively). Follow-up treatment; ANA-positive patients' did not experience statistically significant haematological complications, flare-up of serum transaminases, thyroid dysfunction. No systemic autoimmune disorders developed during follow-up.
ANA positivity is not a factor in chronic HCV disease progression and does not affect the treatment response. Pegylated interferon and ribavirin therapy is safe and effective in autoantibodies-positive chronic HCV patients with no need for further follow-up or worry during the treatment in absence of systemic autoimmune disorders.
慢性丙型肝炎（HCV）患者血清自身抗体的发生率高于普通人群。聚乙二醇干扰素和利巴韦林治疗可诱导患者出现自身免疫表现。自身抗体阳性与治疗应答的相关性具有局限性和争议性。本研究旨在检测慢性 HCV 患者血清自身抗体的发生率及其对组织病理学和治疗应答的影响。
本研究为回顾性研究，纳入了 2007 年至 2010 年期间在埃及国家 HCV 治疗计划中接受聚乙二醇干扰素和利巴韦林治疗的 3673 例埃及初治慢性 HCV 患者。采用酶联免疫吸附法（ELISA）检测抗核抗体（ANA），间接免疫荧光法检测滴度≥1:40 为阳性。对治疗前ANA 阳性患者的血清转氨酶、甲状腺功能和肝活检进行检查，并对其治疗期间和持续病毒学应答（SVR）进行随访，与 ANA 阴性患者进行比较。
研究患者中血清 ANA 阳性率为 1.6%。ANA 阳性和阴性患者在人口统计学、生化和组织病理学数据方面无统计学差异。ANA 阳性和阴性患者的 SVR 相当（分别为 67.8%和 61.3%）。随访治疗期间，ANA 阳性患者未出现明显的血液学并发症、血清转氨酶升高、甲状腺功能障碍。随访期间未发生系统性自身免疫性疾病。
ANA 阳性不是慢性 HCV 疾病进展的影响因素，也不影响治疗应答。聚乙二醇干扰素和利巴韦林治疗对 ANA 阳性慢性 HCV 患者安全有效，无需进一步随访或担心在无系统性自身免疫性疾病的情况下进行治疗。
