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目的分析乙肝病毒(HBV)感染者血清中抗核抗体(ANA)的特征并探讨其与临床的相关性。方法慢性乙型肝炎(CHB)、乙肝后肝硬化(LC)、原发性肝癌(HCC)患者共569例,采用间接免疫荧光法(IIF)检测ANA、AMA、SMA、LSP等自身抗体;免疫印迹法检测ANA谱。结果1)569例中ANA阳性245例(43%),CHB、LC、HCC组ANA检出率分别为42.1%(90/214)、38.2%(108/283)、65.3%(47/72),3组均明显高于正常对照组6.7%(2/30),HCC组ANA阳性率显著高于CHB组和LC组(P<0.01)。2)CHB、LC和HCC组ANA以低滴度(1∶100)为主,分别为75.6%(68/90)、68.5%(74/108)、66%(31/47)。3组中ANA荧光模式以颗粒型常见;抗核仁型抗体的比例在HCC组中最高为19.1%(9/47)。3)45例ANA≥1∶320的患者检测了ANA谱,仅2例LC患者dsDNA阳性,1例LC患者SSA阳性,余患者阴性。4)ANA滴度1∶100组与≥1∶320组的ALT、AST、HBVDNA各指标比较,差异无统计学意义。结论HBV感染者出现的自身抗体以ANA为主,HCC组阳性率最高。ANA荧光模式以颗粒型常见,核仁型在HCC和LC组高于CHB组。70.6%的HBV感染者ANA为低滴度阳性,其滴度的高低与肝细胞损伤未见明显相关性。
Objective To analyze the characteristics of antinuclear antibody (ANA) in serum of patients with hepatitis B virus (HBV) infection and to explore its clinical relevance. Methods A total of 569 patients with chronic hepatitis B (CHB), cirrhosis (LC) and primary hepatocellular carcinoma (HCC) were enrolled. Autoantibodies such as ANA, AMA, SMA and LSP were detected by indirect immunofluorescence assay ANA spectra were detected by blotting. RESULTS: The positive rate of ANA in 569 cases (43%) was 42.1% (90/214), 38.2% (108/283), 65.3% (47/72) in CHB, LC and HCC respectively . The positive rate of ANA in HCC group was significantly higher than that in CHB group and LC group (6.7%, P <0.01). 2) The ANAs in CHB, LC and HCC groups were mainly low titer (1: 100), which were 75.6% (68/90), 68.5% (74/108) and 66% (31/47), respectively. The ANA fluorescence patterns of the three groups were found to be granular, with the highest percentage of anti-nucleolar antibodies in the HCC group being 19.1% (9/47). 3) ANA spectra were detected in 45 ANA≥1: 320 patients, dsDNA was positive in only two patients with LC, SSA was positive in one patient with LC, and negative in the other patients. 4) There was no significant difference in ALT, AST and HBVDNA between ANA titer 1:100 group and ≥1: 320 group. Conclusion The main autoantibodies in patients with HBV infection are ANA, and the positive rate in HCC group is the highest. ANA fluorescence patterns are common in granular type, nucleolar type is higher in HCC and LC group than in CHB group. 70.6% of HBV-infected patients with low-positive ANA titer, the level of its titers and liver cell damage was not significantly correlated.