García-Buey L, García-Monzón C, Rodriguez S, Borque M J, García-Sánchez A, Iglesias R, DeCastro M, Mateos F G, Vicario J L, Balas A
Liver Unit, Hospital de la Princesa, Universidad Autónoma de Madrid, Spain.
Gastroenterology. 1995 Jun;108(6):1770-7. doi: 10.1016/0016-5085(95)90139-6.
BACKGROUND/AIMS: Interferon can induce autoantibodies and autoimmune reactions. This study reviewed the clinical, serological, and HLA phenotypical features of patients who developed autoimmune hepatitis during interferon therapy for chronic hepatitis C, analyzing their response to immunosuppressive treatment.
The diagnosis of chronic hepatitis C was based on positivity for viral RNA and a liver biopsy specimen obtained before interferon treatment. Sera were tested for autoantibodies by indirect immunofluorescence assay. HLA typing was performed by applying a standard microlymphocytotoxicity method.
Of 144 patients with chronic hepatitis C treated with interferon, 7 women deteriorated during treatment; serum transaminase, gamma-globulin, and immunoglobulin G levels increased; and serum autoantibodies became positive. Interferon was interrupted, a diagnosis of autoimmune hepatitis was established, and immunosuppressive therapy was initiated. All patients responded to this treatment. The 7 patients had similar HLA typing to those with autoimmune hepatitis, with DR4 in 2 patients (67%) with type 2 autoimmune hepatitis, and with DR3 and DR52 in 2 (50%) and 4 (100%) patients, respectively, with type 1 autoimmune hepatitis; additionally, 5 patients (71%) had DQ2, and 4 (57%) had both DR52 and DQ2.
In female patients with chronic hepatitis C, a genetic susceptibility to autoimmune hepatitis may exist, possibly triggered by immunostimulating effects during interferon therapy. Immunosuppressive treatment has been well tolerated and seems to be effective.
背景/目的：干扰素可诱导自身抗体和自身免疫反应。本研究回顾了慢性丙型肝炎患者在干扰素治疗期间发生自身免疫性肝炎的临床、血清学和HLA表型特征，并分析了他们对免疫抑制治疗的反应。
慢性丙型肝炎的诊断基于病毒RNA阳性以及干扰素治疗前获得的肝活检标本。通过间接免疫荧光法检测血清中的自身抗体。采用标准微量淋巴细胞毒方法进行HLA分型。
144例接受干扰素治疗的慢性丙型肝炎患者中，7例女性在治疗期间病情恶化；血清转氨酶、γ-球蛋白和免疫球蛋白G水平升高；血清自身抗体呈阳性。中断干扰素治疗，确诊为自身免疫性肝炎，并开始免疫抑制治疗。所有患者对该治疗均有反应。这7例患者的HLA分型与自身免疫性肝炎患者相似，2例2型自身免疫性肝炎患者中有2例（67%）为DR4，1型自身免疫性肝炎患者中分别有2例（50%）和4例（100%）为DR3和DR52；此外，5例患者（71%）有DQ2，4例患者（57%）同时有DR52和DQ2。
在慢性丙型肝炎女性患者中，可能存在对自身免疫性肝炎的遗传易感性，可能由干扰素治疗期间的免疫刺激作用触发。免疫抑制治疗耐受性良好且似乎有效。
