HBV感染者血清自身抗体的检测分析

目的探讨HBV感染者体内自身免疫的变化情况。方法选取120例HBV感染者作为HBV阳性组,其中HBV携带者,乙型肝炎,肝硬化,肝癌患者各30例;同时选取50例健康体检者作为对照组。采用间接荧光法测120例HBV感染者及50例健康体检者血清中抗核抗体（ANA）及抗平滑肌抗体（SMA）,采用酶联免疫吸附法测抗线粒体抗体M2型（AMA-M2）,采用散色比浊法测类风湿因子（RF）,采用印迹法测抗可溶性肝抗原/抗肝胰抗原抗体（SLA/LP）、抗肝肾微粒体抗体I型（LKM-1）、抗肝细胞浆抗体I型（LC-1）。结果 （1）HBV阳性组自身抗体总阳性率为48.3%,高于正常对照组的4%（χ2=30.375,P〈0.05）;（2）HBV携带组、肝炎组、肝硬化组、肝癌组自身抗体阳性率分别为40%、40%、56.7%、56.7%,组间比较χ2=3.337,P=0.343,差异无统计学意义;（3）自身抗体以ANA、RF为主,ANA滴度以1∶100为主,荧光类型以＂均质型＂、＂颗粒型＂为主;（4）对ANA滴度≥1∶320者进行肝谱分析,肝硬化组有2例AMA-M2阳性,说明HBV感染有自身免疫肝病发生的可能;（5）自身抗体阴性组和阳性组AST比较,差异有统计学意义（P〈0.05）,表明自身抗体在肝功能破坏方面起一定的作用。结论 HBV感染者体内存在多种自身抗体,并由于自身抗体的存在造成肝功能进一步损伤,应引起临床医生的高度重视。

Analysis of serum autoantibodies in patients with HBV infection

Objective To investigate the condition of autoimmunity in patients infected with the hepatitis B virus （HBV）. Methods Serum samples were collected from 120 HBV - infected patients and 50 healthy controls. Antinuelear antibodies （ANA） and smooth muscle antibodies （SMA） were detected by indirect immunofluorescence. Antimitochondrial antibody - M2 antigen （ AMA - M2） was detected by enzyme -linked immunosorbent assay. Rheumatoid factor （RF） was detected by a scatter turbidity method. Antibodies against soluble liver antigen （SLA/LP） , liver kidney microsomal （ LKM - 1 ） , and liver cystosol antigen type 1 （ LC - 1 ） were detected by immunoblotting. Results The positive rate autoantibodies was significantly higher in the HBV - infected patients （48.3% vs. controls： 4.0% , X2=30. 375, P 〈 0.05. However, among the HBV - infected patients, there were no significant differences in the positive rates of autoantibodies between the sub -groups of HBV carriers （40.0%） , hepatitis （40.0%） , hepatic sclerosis （56.7%） , and hepatic cancer （56.7%） （X2 = 3. 337, P = 0. 343）. ANA and RF were the most frequently detected autoantibodies. The ANA titer was mostly 1： 100, and the ANA pattern was mostly of the ＂homogeneous type＂ or ＂granular type＂. The liver profile （IgG） was taken for patients with ANA titer ≥ 1：320 and as a result there were only two positive samples of AMA - M2 in the hepatic sclerosis group, indicating that HBV infection can induce autoimmune liver disease. The levels of aspartate aminotransferase were significantly different between the HBV - infected patients who were negative for autoantibodies and those who were positive for autoantibodies （ P = 0. 007 ）, indicating that the autoantibodies contributed to liver function damage. Conclusion HBV - infected individuals express many kinds of autoantibodies, which may promote damage to liver function and should be paid attention to by treating physicians.