乙型肝炎孕妇肝特异性自身抗体的检测与分析

目的了解感染乙型肝炎病毒（HBV）的孕妇肝特异性自身抗体的存在状况并探讨其临床意义。方法应用间接免疫荧光（IIF）法检测108例感染HBV的孕妇、75例感染HBV的未孕女性及40名健康孕妇的血清抗核抗体（ANA）、抗线粒体抗体（AMA）、抗平滑肌抗体（SMA）；采用斑点免疫印迹法（WB）检测受检者的肝抗原自身抗体谱[抗肝肾微粒体1（LKM-1）、抗肝细胞溶质抗原1（LC-1）、抗可溶性肝抗原／抗肝胰抗原（SLA／LP）、抗线粒体-2型（AMA—M2]，同时检测受检者的肝功能、免疫指标。结果健康组检出3例，阳性率7．50％，感染HBV的孕妇血清中有23例检出至少1种自身抗体，总阳性率为21．30％，感染HBV的未孕女性中有18例检出至少1种自身抗体，总阳性率为24．00％，二者差异无统计学意义（P〉0．05），但均显著高于健康孕妇对照组（P〈0．05）。共检出12例有肝特异性自身抗体的患者，其肝功能、免疫球蛋白明显升高。结论感染HBV的孕妇体内产生多种自身抗体，部分HBV孕妇可能重叠自身免疫性肝炎（AIH），体内肝特异性自身抗体的存在与肝功能损害密切相关。

Detection of serum liver specific autoantibodies in pregnant women with hepatitis B virus infection

Objective To determine liver specific autoantibodies in pregnant women with hepatitis B virus （HBV） infection and to explore its clinical significance. Methods Anti-nuclear antibodies（ANA） ,anti-mitochondria antibodies （AMA） and anti-smoth muscle antibodies（SMA） of 108 pregnant women with HBV infection, 75 unpregnant women with HBV infection and 40 healthy pregnant women were detected by indirect immunofluorescence（IIF） assay, and anti- liver-kidney microsomal antibodies（ anti-LKM-1 ）, anti-liver cytosolic-1 antigen（ anti-LC-1 ） antibodies, anti-soluble liver antigen/liver pancreas（anti-SLA/LP） and anti-AMA-M2 of them were measured by indirect Western blot（WB）. Liver dysfunction and immune parameters of these subjects were also measured. Results Autoantibodies were detected in 3 cases of healthy group, the positive rate was 7.50%. At least a kind of autoantibodies was positive in 23/108 HBV pregnant women and in 18/75 HBV infected unpregnant women ,their total positive rate of autoantibodies was 21.30% and 24.00% respectively, their difference was not significant （ P 〉 0. 05 ）, but significantly higher compared with healthy pregnant women （P 〈 0. 05 ）. Liver specific autoantibodies were detected in 12 patients, and their liver dysfunction and immune parameters were significantly high. Conclusions HBV infection in pregnant women can induce autoimmune reaction resulting in production of autoantibodies, and some pregnant women with HBV infection have overlap syndromes with autoimmune hepatitis（AIH）. The liver specific autoantibodies in women with HBV infection have close connection with severity of liver dysfunction.