甲型肝炎患儿自身免疫的血清学标志物：与急性和暴发性表现的关系。

Serological markers of autoimmunity in children with hepatitis A: relation to acute and fulminant presentation.

作者信息

Abdel-Ghaffar Tawhida Y, Sira Mostafa M, Sira Ahmad M, Salem Tahany A, El-Sharawy Ahmed A, El Naghi Suzan

机构信息

aYassin Abdel-Ghaffar Charity Center for Liver Disease and Research bDepartment of Pediatrics, Faculty of Medicine, Ain Shams University cPediatric Department, National Hepatology and Tropical Medicine Research Institute, Cairo Departments of dPediatric Hepatology eClinical Pathology, National Liver Institute, Menofiya University, Menofiya, Egypt.

出版信息

Eur J Gastroenterol Hepatol. 2015 Oct;27(10):1161-9. doi: 10.1097/MEG.0000000000000413.

DOI:10.1097/MEG.0000000000000413

PMID:26062080

Abstract

OBJECTIVES

Hepatitis A virus (HAV) infection tends to be a self-limiting disease without serious sequelae, but fulminant hepatitis, with a high mortality, develops in 0.1-0.2% of the cases. Sometimes, HAV infection precipitates autoimmune hepatitis (AIH). We aimed to assess the frequency and clinical significance of serologic markers of autoimmunity during hepatitis A infection with an acute or fulminant presentation compared with those in AIH.

METHODS

The study included 126 children: 46 with HAV infection (33 with acute and 13 with fulminant presentation), 53 with AIH, and 27 healthy controls. In all, we measured autoantibodies titer (antinuclear antibody, antismooth muscle antibody, and liver kidney microsomal antibody-1) and serum gammaglobulins.

RESULTS

Autoantibodies were detected in the majority of HAV (63.1%) and AIH (79.2%) groups, but in none of the controls. Gammaglobulins were significantly higher in the HAV group (1.93±0.57 g/dl) than in the controls (1.32±0.29 g/dl), but lower than that in the AIH group (2.93±1.2 g/dl) (P<0.0001 for all). In the HAV group, gammaglobulins were significantly higher in those with fulminant (2.21±0.46 g/dl) than in those with acute presentation (1.82±0.57 g/dl) (P=0.019), but comparable with that in AIH (P=0.095). Gammaglobulins correlated significantly with disease severity in both HAV and AIH groups.

CONCLUSION

Hypergammaglobulinemia and a high occurrence of autoantibodies are encountered in HAV infection. This may support the immunological basis of its pathogenesis. Moreover, the higher gammaglobulins in fulminant HAV, with an insignificant difference from that in AIH, suggest that a more aggressive immunological reaction is related to this presentation.

摘要

目的

甲型肝炎病毒（HAV）感染往往是一种自限性疾病，不会产生严重后遗症，但暴发性肝炎在0.1%-0.2%的病例中会发生，其死亡率很高。有时，HAV感染会引发自身免疫性肝炎（AIH）。我们旨在评估与AIH相比，急性或暴发性甲型肝炎感染期间自身免疫血清学标志物的频率及临床意义。

方法

该研究纳入了126名儿童：46名HAV感染患儿（33名急性感染和13名暴发性感染），53名AIH患儿，以及27名健康对照。我们总共检测了自身抗体滴度（抗核抗体、抗平滑肌抗体和肝肾微粒体抗体-1）以及血清球蛋白。

结果

大多数HAV组（63.1%）和AIH组（79.2%）检测到自身抗体，但对照组均未检测到。HAV组的球蛋白（1.93±0.57g/dl）显著高于对照组（1.32±0.29g/dl），但低于AIH组（2.93±1.2g/dl）（所有P<0.0001）。在HAV组中，暴发性感染患儿的球蛋白（2.21±0.46g/dl）显著高于急性感染患儿（1.82±0.57g/dl）（P=0.019），但与AIH组相当（P=0.095）。在HAV组和AIH组中，球蛋白均与疾病严重程度显著相关。