目的 探讨HBV感染者体内自身免疫的变化情况.方法 选取120例HBV感染者作为HBV阳性组,其中HBV携带者,乙型肝炎,肝硬化,肝癌患者各30例；同时选取50例健康体检者作为对照组.采用间接荧光法测120例HBV感染者及50例健康体检者血清中抗核抗体(ANA)及抗平滑肌抗体(SMA),采用酶联免疫吸附法测抗线粒体抗体M2型(AMA-M2),采用散色比浊法测类风湿因子(RF),采用印迹法测抗可溶性肝抗原/抗肝胰抗原抗体(SLA/LP)、抗肝肾微粒体抗体Ⅰ型(LKM-1)、抗肝细胞浆抗体Ⅰ型(LC-1).结果 (1)HBV阳性组自身抗体总阳性率为48.3％,高于正常对照组的4％(x2=30.375,P＜0.05)；(2) HBV携带组、肝炎组、肝硬化组、肝癌组自身抗体阳性率分别为40％、40％、56.7％、56.7％,组间比较x2=3.337,P=0.343,差异无统计学意义；(3)自身抗体以ANA、RF为主,ANA滴度以1∶100为主,荧光类型以“均质型”、“颗粒型”为主；(4)对ANA滴度≥1∶320者进行肝谱分析,肝硬化组有2例AMA-M2阳性,说明HBV感染有自身免疫肝病发生的可能；(5)自身抗体阴性组和阳性组AST比较,差异有统计学意义(P＜0.05),表明自身抗体在肝功能破坏方面起一定的作用.结论 HBV感染者体内存在多种自身抗体,并由于自身抗体的存在造成肝功能进一步损伤,应引起临床医生的高度重视.%Objective To investigate the condition of autoimmunity in patients infected with the hepatitis B virus (HBV).Methods Serum samples were collected from 120 HBV-infected patients and 50 healthy controls.Antinuclear antibodies (ANA) and smooth muscle antibodies (SMA) were detected by indirect immunofluorescence.Antimitochondrial antibody-M2 antigen (AMA-M2) was detected by enzyme-linked immunosorbent assay.Rheumatoid factor (RF) was detected by a scatter turbidity method.Antibodies against soluble liver antigen (SLA/LP),liver kidney microsomal (LKM-1),and liver cystosol a,ntigen type 1 (LC-1) were detected by immunoblotting.Results The positive rate autoantibodies was significantly higher in the HBV-infected patients (48.3％ vs.controls:4.0％,x2 =30.375,P ＜ 0.05.However,among the HBV-infected patients,there were no significant differences in the positive rates of autoantibodies between the sub-groups of HBV carriers (40.0％),hepatitis (40.0％),hepatic sclerosis (56.7％),and hepatic cancer (56.7％)(x2 =3.337,P =0.343).ANA and RF were the most frequently detected autoantibodies.The ANA titer was mostly 1∶ 100,and the ANA pattern was mostly of the "homogeneous type" or "granular type".The liver profile (IgG) was taken for patients with ANA titer ≥ 1∶ 320and as a result there were only two positive samples of AMA-M2 in the hepatic sclerosis group,indicating that HBV infection can induce autoimmune liver disease.The levels of aspartate aminotransferase were significantly different between the HBV-infected patients who were negative for autoantibodies and those who were positive for autoantibodies (P =0.007),indicating that the autoantibodies contributed to liver function damage.Conclusion HBV-infected individuals express many kinds of autoantibodies,which may promote damage to liver function and should be paid attention to by treating physicians.
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