孕妇乙型肝炎病毒感染与血清自身抗体的相关性研究

目的探讨孕妇乙型肝炎病毒(HBV)感染与自身抗体的相关性。方法采用ELISA、荧光定量PCR对108例乙肝孕妇的HBV标志物(HBVM)、HBVDNA进行检测,同时采用间接免疫荧光法(IIF)、免疫印迹法(WB)分别对HBV孕妇及40例健康孕妇行抗核抗体(ANA)、抗线粒体抗体(AMA)、抗平滑肌抗体(ASMA),可提取核抗原抗体谱(ENA)、肝抗原自身抗体谱(anti-LKM1、anti-LC1、anti-SLA/LP、anti-A-MAM2)检测,采用速率散射法检测RF,采用金标法检测抗-dsDNA。结果108例HBV孕妇检出多种自身抗体,总阳性率为31.48%,显著高于健康孕妇对照组的12.50%(P<0.05),检出的自身抗体以低滴度为主且以ANA,RF为多见。HBV阳性孕妇自身抗体阳性组与自身抗体阴性组的年龄、妊娠周期及ALT水平无明显差异(P>0.05),而HBeAg或/和HBVDNA阳性组自身抗体的检出率显著高于HBeAg或/和HBVDNA阴性组(P<0.01)。108例HBV孕妇检出1例ANA、ASMA同时阳性且滴度较高,2例anti-SLA/LP阳性,1例anti-LKM1阳性,其肝功能明显损害。结论孕妇HBV感染可引发机体自身免疫反应,产生多种以低滴度为主的自身抗体,这种免疫反应与HBV复制水平有关,而与孕妇年龄、孕周及ALT无关,且部分HBV孕妇可能重叠自身免疫性肝炎(AIH)。

Study on relationship between autoantibodies and HBV infection in pregnant women

[Objective] To investigate the relationship between infection of HBV and development of autoantibodies in pregnant women. [Methods] HBVM and HBV DNA were detected in the serum of 108 HBV pregnant women and 30 healthy pregnant women by ELISA and FQ-PCR, respectively. ANA, AMA, ASMA, ENA, anti-LKM1, anti-LC1, anti-SLA/LP, anti-AMAM2, RF, anti-dsDNA were measured by using indinect immunofluorescence (IIF), western blot(WB), turbidimentricassay and colloidal gold, respectively. [Results] The positive rate of autoantibodies in HBV pregnant women was significantly higher compared to those in healthy pregnant women (31.48% vs 12.50%, P <0.05). Low titer of autoantibodies were presented in the HBV pregnant women, and most of them were ANA and RF. There was no remarkable difference in the age, pregnant cycle and ALT between the autoantibodies positive group and autoantibodies negative group (P >0.05), but the positive rate of autoantibodies in the HBV pregnant women with HBV DNA or HBeAg was remarkably higher than those without (P <0.01). In the 108 cases HBV pregnant women, 1 case had high titer of ANA and ASMA, 2 cases had anti-SLA/LP, and 1 case had anti-LKM1. [Conclusions] HBV infection in pregnant women can induce autoimmune reactions, resulting in production of autoantibodies. The autoimmune reaction has no connection with age, gestation weeks and the liver dysfunction severity. It is in connection with the positive rate of HBV DNA or HBeAg, and some pregnant women with HBV had overlap syndromes with autoimmune hepatitis(AIH).