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目的:检测乙型肝炎自身抗体的阳性率,探讨乙型肝炎自身抗体存在的临床意义。方法:分别采用间接免疫荧光法(IIF)和免疫印迹法(Western-blot)检测453例乙型肝炎、162例自身免疫性肝炎(AIH)和96例正常人抗核抗体(ANA)的阳性率、ANA阳性滴度、核型和抗双链DNA抗体(dsDNA)的阳性率以及肝炎相关自身抗体:抗平滑肌抗体(SMA)、抗肝肾微粒体抗体(LKM)的阳性率。应用酶法检测患者的ALT和AST,实时荧光定量PCR技术检测HBV DNA。结果:①乙肝组ANA的阳性率为22.7%,ANA以低滴度(1∶100)为主,仅3例乙肝后肝硬化的滴度为1∶320;ANA核型以均质型为主,仅5例为斑点型,显著低于AIH组(P<0.01)。其中急性乙肝、慢性乙肝、重症乙肝和乙肝后肝硬化ANA的阳性率分别为5.2%、22.8%、24.2%和37.9%,慢性乙肝、重症乙肝和乙肝后肝硬化患者ANA的阳性率显著高于急性乙肝(P<0.05或P<0.01),乙肝后肝硬化组明显高于乙肝炎组(P<0.05或P<0.01)。②ANA阳性乙肝患者伴有dsDNA抗体,用Western-blot法检测dsDNA的阳性率为10.34%,显著高于ANA阴性的乙肝患者(P<0.05),乙肝组dsDNA的阳性率为2.42%与AIH组差异无统计学意义(P>0.05)。③乙型肝炎存在SMA和LKM,但仅有较低的阳性率分别为4.63%和3.31%,显著低于AIH组(P<0.01)。④乙型肝炎ANA阳性组的ALT、AST水平和HBV DNA阳性率显著高于ANA阴性组(P<0.05);乙肝组ALT、AST水平和HBV DNA阳性率显著高于AIH组(P<0.01)。结论:HBV感染不仅引起肝组织损害,还诱导产生多种以低滴度为主的自身抗体。自身抗体的产生与肝损伤程度有一定相关性,并与HBV复制水平相关;其在探讨乙肝发生、发展机制和病因研究中有一定的意义。
Objective: To detect the positive rate of hepatitis B autoantibodies and to explore the clinical significance of the existence of autoantibodies to hepatitis B. Methods: The positive rate of 453 cases of hepatitis B, 162 cases of autoimmune hepatitis (AIH) and 96 cases of normal human antinuclear antibody (ANA) were detected by indirect immunofluorescence (IIF) and Western-blotting , The positive rate of ANA positive titer, the positive rate of karyotype and anti-double-stranded DNA antibody (dsDNA) and the positive rate of anti-smooth muscle antibody (SMA) and anti-liver and kidney microsomal antibody (LKM) Patients’ ALT and AST were detected enzymatically and HBV DNA was detected by real-time fluorescence quantitative PCR. Results: ① The positive rate of ANA in group B was 22.7%, the number of ANA in group A was low (1: 100), and the titer of liver cirrhosis was only 1: 320 in group B. The ANA karyotype was mainly of homogeneous type , Only 5 cases were spot-type, significantly lower than the AIH group (P <0.01). The positive rates of ANA in acute hepatitis B, chronic hepatitis B, severe hepatitis B and posthepatitic cirrhosis ANA were 5.2%, 22.8%, 24.2% and 37.9% respectively. The positive rates of ANA in patients with chronic hepatitis B, severe hepatitis B and hepatitis B and liver cirrhosis were significantly higher than those with ANA Acute hepatitis B (P <0.05 or P <0.01), hepatitis B cirrhosis was significantly higher than that of hepatitis B (P <0.05 or P <0.01). The positive rate of dsDNA detected by Western-blot was 10.34%, which was significantly higher than that of ANA-negative hepatitis B patients (P <0.05). The positive rate of dsDNA in hepatitis B group was 2.42% and that of AIH group No statistical significance (P> 0.05). ③ The presence of SMA and LKM in hepatitis B, but only the low positive rates were 4.63% and 3.31%, respectively, which were significantly lower than those in AIH group (P <0.01). ④ The ALT and AST levels and the positive rate of HBV DNA in ANA-positive hepatitis B group were significantly higher than those in ANA negative group (P <0.05). The levels of ALT and AST and the positive rate of HBV DNA in hepatitis B group were significantly higher than those in AIH group (P <0.01) . Conclusion: HBV infection not only causes liver damage, but also induces many kinds of autoantibodies with low titer. The production of autoantibodies has a certain correlation with the degree of liver injury, and is correlated with the level of HBV replication. It has some significance in the study of the pathogenesis, development mechanism and etiopathogenesis of hepatitis B.