Matsuda J, Saitoh N, Gotoh M, Gohchi K, Tsukamoto M, Syoji S, Miyake K, Yamanaka M
Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan.
Am J Gastroenterol. 1995 Jul;90(7):1138-41.
We investigated the prevalence rate of beta 2-glycoprotein I (beta 2-GPI)-dependent antiphospholipid antibodies (aPL)[anti-cardiolipin antibody (aCL), anti-phosphadidylserine antibody (aPS), and anti-phosphatidic acid antibody (aPA)], antinuclear antibody (ANA), anti-deoxyribonucleic acid antibody (aDNA), anti-thyroglobulin antibody (aTG), and anti-thyroid peroxidase antibody (aTPO) in 56 patients with hepatitis C virus (HCV) infection and correlated the results with inteferon-alpha (IFN) treatment.
aCL, aPS, and aPA were positive in, respectively, 7/56 (13%), 12/56 (21%), and 13/56 (23%) patients before treatment. aPS and aPA appeared in 6/44 and 9/43 and disappeared in 6/12 and 2/13 patients, respectively, after IFN treatment; the differences were statistically significant. The changes in OD readings were higher in the group of patients who became positive for aPS and aPA than in those who became negative after treatment. The positive rates of aTG and aTPO in the patient group were statistically higher than in the healthy controls, and aTG developed in four patients and disappeared in two. No obvious changes in aTPO were observed; however, the aTPO titer was increased in four previously positive patients. None of the patients positive for any antibodies developed an abnormality associated with these antibodies during an observation period of up to 1 yr.
The pathogenesis of production and clinical significance of aPL, ATG/aTPO in this clinical setting are unclear, but immunological disturbances, such as the effects of HCV infection and/or IFN treatment, were considered to be a possibility. Further investigation is needed to clarify whether HCV/aPL- and/or aTG/aTPO-positive patients treated with IFN might develop aPL-associated complications and/or autoimmune disease(es), in the future and to confirm whether IFN treatment justifies the outcome in this clinical setting.
我们调查了56例丙型肝炎病毒(HCV)感染患者中β2-糖蛋白I(β2-GPI)依赖性抗磷脂抗体(aPL)[抗心磷脂抗体(aCL)、抗磷脂酰丝氨酸抗体(aPS)和抗磷脂酸抗体(aPA)]、抗核抗体(ANA)、抗脱氧核糖核酸抗体(aDNA)、抗甲状腺球蛋白抗体(aTG)和抗甲状腺过氧化物酶抗体(aTPO)的患病率,并将结果与α干扰素(IFN)治疗进行关联分析。
治疗前,aCL、aPS和aPA阳性患者分别为7/56(13%)、12/56(21%)和13/56(23%)。IFN治疗后,aPS和aPA分别在6/44和9/43患者中出现,在6/12和2/13患者中消失;差异具有统计学意义。aPS和aPA转为阳性的患者组OD读数变化高于治疗后转为阴性的患者组。患者组中aTG和aTPO的阳性率在统计学上高于健康对照组,4例患者出现aTG,2例患者aTG消失。未观察到aTPO有明显变化;然而,4例先前阳性患者的aTPO滴度升高。在长达1年的观察期内,任何抗体阳性的患者均未出现与这些抗体相关的异常情况。
在这种临床情况下,aPL、ATG/aTPO产生的发病机制及临床意义尚不清楚,但免疫紊乱,如HCV感染和/或IFN治疗的影响,被认为是一种可能性。需要进一步研究以阐明未来接受IFN治疗的HCV/aPL和/或aTG/aTPO阳性患者是否可能发生aPL相关并发症和/或自身免疫性疾病,并确认IFN治疗在这种临床情况下是否合理。