Meyer zum Büschenfelde K H
I. Medizinische Klinik und Poliklinik, Johannes-Gutenberg-Universität, Mainz, BRD.
Schweiz Med Wochenschr. 1987 Jul 18;117(29):1065-75.
Acute hepatitis A is diagnosed by IgM-anti-HAV antibodies. Cytotoxic immune reactions seem to play a key role in the pathogenesis of hepatitis A, which is an acute self-limited disease. - Acute hepatitis B is diagnosed by IgM-anti-HBc antibodies and can thus be differentiated from other HBV-associated liver diseases. The detection of HBV-DNA in serum serves to differentiate between HBsAg/anti-HBe positive patients, with active viral replication and progressive chronic liver disease, and HBV-DNA negative asymptomatic HBsAg-carriers usually with normal liver histology. In the pathogenesis of HBV-associated liver diseases cytotoxic immune reactions against virus-infected hepatocytes are thought to mediate liver cell destruction. Membrane expressed virus as well as host antigens are candidate target antigens for these immune reactions. Hepatitis delta is always associated with acute and chronic HBV infection. Acute hepatitis delta is diagnosed by delta-RNA in serum and later by antibodies against the delta virus. Little is known about the pathogenesis of delta virus infection. Autoimmune type chronic active hepatitis (CAH) is classified into classical autoimmune type "lupoid CAH" with antinuclear antibodies and liver membrane antibodies as markers, liver-kidney-microsomal (LKM) antibody positive CAH, CAH associated with autoantibodies against a soluble liver antigen (SLA), and CAH associated with high titers of anti-smooth muscle antibodies (SMA). In the pathogenesis of autoimmune type CAH an antibody-mediated cellular cytotoxicity (ADCC) may play a significant role. Primary biliary cirrhosis is to be differentiated as a clinical syndrome associated with cholestasis and anti-mitochondrial antibodies (AMA). By immunoblotting and radioimmunoassay at least two PBC-specific subtypes of AMA can be defined. Immune reactions against self-antigens are thought to be involved in the pathogenesis of PBC, although the precise reactions are unknown.
急性甲型肝炎通过 IgM 抗 HAV 抗体诊断。细胞毒性免疫反应似乎在甲型肝炎的发病机制中起关键作用，甲型肝炎是一种急性自限性疾病。 - 急性乙型肝炎通过 IgM 抗 HBc 抗体诊断，因此可与其他乙肝相关肝病相鉴别。血清中 HBV-DNA 的检测有助于区分 HBsAg/抗 HBe 阳性且有活跃病毒复制和进行性慢性肝病的患者，以及通常肝组织学正常的 HBV-DNA 阴性无症状 HBsAg 携带者。在乙肝相关肝病的发病机制中，针对病毒感染肝细胞的细胞毒性免疫反应被认为介导肝细胞破坏。膜表达病毒以及宿主抗原是这些免疫反应的候选靶抗原。丁型肝炎总是与急性和慢性乙肝感染相关。急性丁型肝炎通过血清中的丁型 RNA 诊断，随后通过针对丁型病毒的抗体诊断。关于丁型病毒感染的发病机制知之甚少。自身免疫型慢性活动性肝炎（CAH）分为以抗核抗体和肝膜抗体为标志物的经典自身免疫型“狼疮样 CAH”、肝-肾微粒体（LKM）抗体阳性的 CAH、与针对可溶性肝抗原（SLA）的自身抗体相关的 CAH 以及与高滴度抗平滑肌抗体（SMA）相关的 CAH。在自身免疫型 CAH 的发病机制中，抗体介导的细胞毒性（ADCC）可能起重要作用。原发性胆汁性肝硬化作为一种与胆汁淤积和抗线粒体抗体（AMA）相关的临床综合征需加以鉴别。通过免疫印迹和放射免疫测定，至少可定义两种 AMA 的原发性胆汁性肝硬化特异性亚型。尽管确切反应尚不清楚，但针对自身抗原的免疫反应被认为参与了原发性胆汁性肝硬化的发病机制。
