暴发性乙型病毒性肝炎发病机制中乙肝表面抗体产生增强。
Enhanced HBsAb production in pathogenesis of fulminant viral hepatitis type B.
作者信息
Woolf I L, El Sheikh N, Cullens H, Lee W M, Eddleston A L, Williams R, Zuckerman A J
出版信息
Br Med J. 1976 Sep 18;2(6037):669-71. doi: 10.1136/bmj.2.6037.669.
The possible importance of humoral immunity in the pathogenesis of fulminant hepatitis was investigated by comparing 17 patients with fulminant hepatitis type B with 20 patients with severe but non-fulminant disease. Hepatitis B surface antigen (HBsAg) was cleared from the serum significantly faster (P less than 0-001) in those with fulminant hepatitis, and in 41% anti-HBsAg (HBsAb) was detectable by radioimmunoassay (RIA) at presentation. In all 11 sera from patients with fulminant hepatitis that were examined by electron microscopy aggregates of HBsAg and HBsAb were seen. In contrast, HBsAb was never detected by RIA in those with non-fulminant hepatitis, and in only one serum specimen (5%) were aggregates seen on electron microscopy. A significant sex difference between fulminant and non-fulminant hepatitis was observed, 65% of patients with fulminant hepatitis but only 15% of patients with non-fulminant hepatitis being women (P less than 0-01). An enhanced production of HBsAb in fulminant hepatitis, by leading to free HBsAb in portal blood, may cause an Arthus reaction in the sinusoids of the liver with ensuing ischaemic necrosis of hepatocytes.
通过比较17例暴发性乙型肝炎患者和20例重症但非暴发性疾病患者，研究了体液免疫在暴发性肝炎发病机制中的可能重要性。暴发性肝炎患者血清中的乙肝表面抗原（HBsAg）清除速度明显更快（P小于0.001），41%的患者在就诊时通过放射免疫分析（RIA）可检测到抗HBsAg（HBsAb）。在通过电子显微镜检查的所有11例暴发性肝炎患者的血清中，均可见到HBsAg和HBsAb的聚集体。相比之下，非暴发性肝炎患者通过RIA从未检测到HBsAb，仅在一份血清标本（5%）中通过电子显微镜观察到聚集体。观察到暴发性肝炎和非暴发性肝炎之间存在显著的性别差异，暴发性肝炎患者中65%为女性，而非暴发性肝炎患者中仅15%为女性（P小于0.01）。暴发性肝炎中HBsAb产生增强，通过导致门静脉血中出现游离的HBsAb，可能会在肝血窦中引发阿瑟斯反应，继而导致肝细胞缺血性坏死。
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