目的:对慢性乙型肝炎(以下简称“乙肝”)患者在采用干扰素治疗过程中血清自身抗体进行检测和分析,探讨自身抗体在干扰素治疗慢性乙肝患者中的临床意义。方法选取2010年至2015年解放军第三0二医院收治的116例慢性乙肝患者,男性81例,女性35例,平均年龄16(1~52)岁,按照是否采用干扰素治疗分为两组:干扰素治疗组94例,男性65例,女性29例,平均年龄11(1~45)岁;未采用干扰素治疗组22例,男性16例,女性6例,平均年龄36(23~52)岁。同时将干扰素治疗组根据是否检测到自身抗体分为两个亚组:自身抗体阳性组46例,男性33例,女性13例,平均年龄10(1~43)岁;自身抗体阴性组48例,男性32例,女性16例,平均年龄12(2~45)岁。采用间接免疫荧光法和免疫印迹法进行自身抗体的相关检测,对干扰素使用情况与自身抗体产生之间的关系以及自身抗体产生对乙肝治疗的影响进行分析。定量资料采用t检验或t′检验,多组比较采用秩和检验;分类资料用卡方检验。结果干扰素治疗组3年内自身抗体检出46例,阳性率为48.9%,而非干扰素治疗组仅检出5例,阳性率为22.7%,两组间差异有统计学意义(χ2=4.971,P=0.026,P<0.05);干扰素治疗过程中随治疗时间延长,自身抗体检出的阳性率增加速度逐渐减缓(从33.0%到48.9%);干扰素治疗期间,无论是否产生自身抗体,其 HBeAg 阴转率(χ2=1.625,P=0.202,P>0.05)、HBV DNA阴转率(χ2=0.111,P=0.739,P>0.05)、ALT(t=1.255, P=0.213, P>0.05)、AST (t=0.094, P=0.925, P>0.05)、ALP( t=1.201,P=0.235, P>0.05)差异均无统计学意义;干扰素治疗组中自身抗体阳性组、阴性组肝脏组织炎症分级>2( G>2)者分别为13.0%和2.1%,差异有统计学意义(χ2=4.094,P=0.043, P<0.05)。结论接受干扰素治疗的慢性乙肝患者易出现自身抗体,自身抗体的产生与肝损伤程度有一定的关系,但未发现其对抗病毒治疗预后产生显著影响。(中华检验医学杂志,2016,39:833-836)
Objective To detect and analyze the serum autoantibodies in patients with chronic hepatitis B treated by interferon and to investigate their clinical significance .Methods 116 cases of chronic hepatitis B patients were chosen in the 302 Hospital from 2010 to 2015, including 81 cases of male and 35 cases of women, aged 16 (1-52).According to whether to apply the interferon therapy , the patients are divided into two groups:the interferon treatment group [94 cases including 65 cases of male and 29 cases of women, aged 11 (1-45)] and no interferon treatment group [22 cases including 16 cases of male and 6 cases of women, aged 36 (23-52)].Further, according to whether autoantibodies could be detected , the interferon treatment group was divided into two subgroups:autoantibody positive group of 46 cases, with 33 cases of male and 13 cases of women, aged 10 (1-43) and autoantibody negative group of 48 cases, 32 cases of male and 16 cases of women, aged 12 (2-45).The correlation between the use of interferon and the production of autoantibodies was detected and analyzed by indirect immunofluorescence and western blot methods.The impact of the production of autoantibodies was evaluated on hepatitis B therapy .The statistical significance of quantitative data was determined using t test or t′inspection, with multiple sets of comparison applying rank and inspection and classification of data by chi-square test.Results The detection rate of autoantibodies in the group of interferon treatment , which was 48.9%(46/94), was significantly higher than that in the no treatment group , which was only 22.7%( 5/22 ) (χ2 =4.971, P=0.026, P<0.05 );Following the treatment with interferon , the positive rate of autoantibodies was increased from 33.0% to 48.9%;Whether or not autoantibodies were produced in the treatment group , the HBeAg negative rate (χ2=1.625,P=0.202,P>0.05), HBVDNA negative rate (χ2 =0.111,P=0.739,P>0.05), ALT(t=1.255, P=0.213, P>0.05), AST (t=0.094, P=0.925, P>0.05),ALP(t=1.201,P=0.235, P>0.05) had no statistical significant differences;The percent of the score of inflammation above G 2 in all of the autoantibody positive patients was 13.0%, and it was significantly higher compared with that in the autoantibody negative patients the percent of G >2 was 2.1% (χ2 =4.094, P=0.043, P<0.05 ) . Conclusions The patients with hepatitis B who treated with interferon could conduct the production of autoantibodies.Autoantibody emerging seems to have some correlation with the degree of liver injury . Whether or not autoantibodies produce did not significantly affect the prognosis for the patients .