乙型肝炎病毒感染者血清肝特异性自身抗体的检测及临床意义

目的探讨慢性乙型肝炎病毒（HBV）感染者血清肝特异性自身抗体的检出率及临床意义。方法采用间接免疫荧光法检测186例慢性HBV感染者血清肝特异性自身抗体，回顾性分析AST、ALT、ALP和GGT等生化指标与自身抗体检出率的相关性。结果在186例慢性HBV感染者中检出自身抗体阳性66例（35.5%）；在60例HBV携带者、74例慢性肝炎和52例肝硬化患者肝特异性抗核抗体（ANA）检出率分别为25.0%、24.3%和21.2%，明显高于30例健康对照人群（6.6%，P＜0.05）；自身抗体阳性者以低滴度为主，主要以抗核抗体（ANA）和类风湿因子（RF）阳性为主，免疫荧光模式以“均质型”和“颗粒型”为主；66例自身抗体阳性的HBV感染者血清ALT、AST、ALP和GGT分别为268.4±213.6u/L、241.5±21.3.0u/L、287.2±175.0u/L和168.9±54.7u/L，均显著高于120例自身抗体阴性者（分别为130.8±29.0u/L、118.2±27.3u/L、142.0±63.5u/L和36.5±17.2 u/L，P〈0.01）。结论慢性HBV感染可诱导自身免疫反应而有可能产生多种自身抗体，后者的检出率与肝功能指标显著相关，可能是感染HBV后肝组织损伤的重要因素。

Detection and clinical significance of liver specific autoantibodies in patients with chronic hepatitis B viral infection

Objective To investigate the prevalence of serum liver specific autoantibodies and its clinical significance in patients with chronic hepatitis B virus （HBV）infection. Methods A total of 186 individuals with HBV infection were recruited in the study. Serum liver specific autoantibodies were detected by indirect im-munofluorescence assay. The relationship between the positive rate of the autoantibodies and the biochemical in-dices including ALT,AST,ALP and γ-glutamyltransferase were analyzed retrospectively. Results The positive rate of autoantibodies in this series was 35.5%;The positive rates of ANA in 60 individuals with HBV carrier,74 pa-tients with chronic hepatitis B（CHB）and 52 with cirrhosis were 25.0%,24.3% and 21.2%,respectively,significantly higher than that in 30 healthy control（6.6%,P〈0.05）;The main immunofluorescence patterns of the autoantibodies were morphologically homogeneous and granular;The serum ALT,AST,ALP and γ-glutamyltransferase in 66 indi-viduals with autoantibody-positive were 268.4±213.6u/L,241.5±21.3.0u/L,287.2±175.0u/L and 168.9±54.7u/L,re-spectively,all of which significantly higher than those in 120 with autoantibody- negative（130.8±29.0u/L,118.2±27.3u/L,142.0±63.5u/L and 36.5±17.2u/L,respectively,P〈0.01）. Conclusions Chronic HBV infection might in-duce autoimmune reaction and the autoantibodies are correlated to liver function index,suggesting a pathological effect in hepatic tissue injury after HBV infection.