丙型肝炎的自身免疫现象——鉴别诊断和治疗原则

丙型肝炎病毒(HCV)感染和使用干扰素可诱导丙型肝炎患者产生一系列自身抗体,甚至发生自身免疫性疾病。干扰素诱发自身免疫性疾病后,单纯停用干扰素,自身免疫性疾病不能完全缓解,需要相应治疗,包括应用免疫抑制剂。为研究干扰素治疗丙型肝炎诱发自身免疫性肝炎(AIH)的临床特征,本文分析了日本仓敷医学中心胃肠、肝病和营养科1992～2008年接受干扰素治疗的1626例丙型肝炎患者,结果显示仅1例女性患者最终发展为AIH,予激素治疗后病情缓解。HCV RNA感染后机体可产生非器官特异性自身抗体,干扰素治疗本身亦可诱导自身抗体产生,这种伴发的自身免疫现象并非干扰素治疗的绝对禁忌证,但自身抗体滴度很高时,应慎重使用干扰素。

Autoimmune Phenomenon in Hepatitis C: Differential Diagnosis and Therapeutic Principle

Hepatitis C virus （HCV） infection and interferon （IFN） treatment may induce the occurrence of a series of autoantibodies and even induce autoimmune disease. The autoimmune disease will not relieve completely even IFN treatment has been stopped. Relevant treatment including immunosuppressants may be needed. To clarify the clinical characteristics of autoimmune hepatitis （AIH） induced by IFN, 1626 cases of hepatitis C treated with IFN in the Division of Gastroenterology, Hepatology and Nutrition, Kurasbiki Medical Center, Japan from 1992 to 2008 were analyzed. Among them, only one female patient developed AIH. The patient recovered after steroid therapy. HCV RNA infection may induce the producing of non- organ specific autoantibodies, and IFN treatment itself also can induce the appearance of autoantibodies. Such an associated autoimmune phenomenon is not an absolute contraindication to IFN therapy. However, IFN should be used cautiously when the titers of autoantibodies are very high.