HCV感染者自身抗体对肝脏损伤的影响  

The impact of autoantibodies on liver histology in hepatitis C

作　　者：李文淑[1] 赵景民[2] 周光德[2] 刘树红[2] 郭晓东[2] 杨建法[2] 赵雨来[2] 

机构地区：[1]解放军第302医院新药临床试验中心,北京100039 [2]解放军第302医院病理诊断与研究中心,北京100039

出　　处：《中华临床医师杂志（电子版）》2011年第20期5969-5973,共5页Chinese Journal of Clinicians(Electronic Edition)

基　　金：国家"十一五"科技重大专项(2008ZX10002-013)

摘　　要：目的分析血清自身抗体阳性慢性HCV感染者肝脏详细病理改变,探讨慢性HCV感染者血清自身抗体与肝脏损伤的关系。方法采用间接免疫荧光法测定血清抗核抗体(ANA)、抗平滑肌抗体(SMA)、抗线粒体抗体(AMA)、抗肝肾微粒体抗体(LKM)、抗胃壁细胞抗体(PCA)。采用荧光定量PCR测定HCVRNA载量、HCV基因型,同时检测肝功指标丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、总胆红素(TBIL)、直接胆红素(DBIL)、碱性磷酸酶(ALP)、γ-谷氨酰基转移酶(GGT)。依据Ishak病理评价方案对肝活检组织炎症活动度和纤维化程度进行总体评分和详细组织病理评价。结果 15例(23.81%)慢性HCV感染者自身抗体阳性,其中ANA阳性9例(14.29%)、SMA阳性2例(3.17%)、AMA阳性3例(4.76%)、PCA阳性2例(3.17%),包括ANA、SMA双阳性1例。自身抗体阳性HCV感染者年龄显著大于自身抗体阴性HCV感染者[(44.80±9.61)岁vs.(34.04±13.18)岁,P=0.005],自身抗体阳性HCV感染者血清ALT、AST、GGT水平显著升高,肝脏炎症活动度评分显著高于自身抗体阴性HCV感染者,其中融合坏死和点灶状坏死较重,未见其他临床指标和组织学差异。结论 HCV感染者血清自身抗体会导致以融合坏死和点灶状坏死加重为主的肝脏组织学病变。Objective To evaluate the detailed pathological changes in liver tissues of autoantibody-positive patients with chronic hepatitis C virus (HCV) infection and to explore the association between autoantibodies and liver injury of chronic HCV infection.Methods A retrospective study was performed based on a total of 63 patients with chronic HCV infection.Autoantibodies were detected in all the patients,including antinuclear antibody (ANA),anti-smooth muscle antibody (SMA),anti-mitochondrial antibody (AMA),anti-liver/kidney microsomal antibody (LKM) and parietal cell autoantibody (PCA),using indirect immunofluorescence assay.HCV RNA,viral genotype,ALT,AST,TBIL,DBIL,ALP and GGT were examined by fluorescent quantitative polymerase chain reaction(RT-PCR).Necroinflammation and fibrosis in liver biopsies were assessed according to Ishak scoring system.Results 15 patients with chronic HCV (23.81%) were autoantibody-positive,consisting of 9 (14.29%) ANA-positive,2 (3.17%) SMA-positive,3 (4.76%) AMA-positive,2 (3.17%) PCA-positive cases as well as 1 positive for both ANA and SMA.Autoantibody-positive patients were significantly older than autoantibody-negative patients (44.80±9.61 vs.34.04±13.18,P=0.005).Autoantibody-positive patients were more likely to have raised serum ALT,AST and GGT levels.Compared with autoantibody-negative patients,the mean inflammation score were significantly higher in autoantibody-positive patients,with frequent confluent necrosis and focal necrosis.No significant difference was observed in other clinical parameters or histological features.Conclusions In HCV-infected patients,serum autoantibody can lead to histological changes featured with confluent necrosis and focal necrosis.

关 键 词：肝炎 丙型 慢性 病理学 自身抗体 组织学 

分 类 号：R512.63[医药卫生—内科学]