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中华临床实验室管理电子杂志

中华临床实验室管理电子杂志 ›› 2020, Vol. 08 ›› Issue (02) : 100 -104. doi: 10.3877/cma.j.issn.2095-5820.2020.02.007

所属专题： 文献；

实验研究

病毒性肝炎患者血清抗核抗体谱检测的临床意义分析
魏秋静1,†(), 蒋雨彤1, 谢洁雯1, 吴中鸣1, 涂柳丹1, 古洁若1   
  1. 1. 510630　广州，中山大学第三附属医院风湿免疫科
  • 收稿日期:2020-05-13 出版日期:2020-05-28
  • 通信作者: 魏秋静

Clinical significance of serum antinuclear antibody profiling in patients with viral hepatitis

Qiujing Wei1,†(), Yutong Jiang1, Jiewen Xie1, Zhongming Wu1, Liudan Tu1, Jieruo Gu1   

  1. 1. Department of Rheumatology and Immunology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou 510630, China
  • Received:2020-05-13 Published:2020-05-28
  • Corresponding author: Qiujing Wei
  • About author:
    Coresponding author: Wei Qiujing, Email:
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引用本文：

魏秋静, 蒋雨彤, 谢洁雯, 吴中鸣, 涂柳丹, 古洁若. 病毒性肝炎患者血清抗核抗体谱检测的临床意义分析[J]. 中华临床实验室管理电子杂志, 2020, 08(02): 100-104.

Qiujing Wei, Yutong Jiang, Jiewen Xie, Zhongming Wu, Liudan Tu, Jieruo Gu. Clinical significance of serum antinuclear antibody profiling in patients with viral hepatitis[J]. Chinese Journal of Clinical Laboratory Management(Electronic Edition), 2020, 08(02): 100-104.

目的

探讨乙型病毒感染肝炎(HBV)、丙型病毒感染肝炎(HCV)患者血清抗核抗体谱检测的临床意义，为临床诊断及疗效提供参考。

方法

回顾性分析1875例HBV、563例HCV、488例体检健康者(HC)的抗核抗体谱(ANAs)阳性分布；根据病毒性肝炎患者抗核抗体谱结果情况分为阳性组和阴性组，收集并分析两组患者一般资料、肝功能指标、免疫球蛋白，纳入有完整资料的患者为456例。

结果

HBV患者的ANAs阳性率为18.40%，HCV患者为11.90%，HC患者为4.10%，病毒性肝炎组与健康对照组的ANAs阳率性有显著性差异(P<0.05)。病毒性肝炎组的ANAs阳性率与HC比较有显著性差异(P<0.05)的抗体有：抗dsDNA抗体、抗Nucleosome抗体、抗Histone抗体、抗SSA/Ro60抗体、抗SSA/Ro52抗体、抗SSB抗体、抗AMA-M2抗体、抗CENP-B抗体。最常见SSA/Ro52抗体阳性；病毒性肝炎组ANAs性别比较，阳性组女性多于阴性组，差异有统计学意义(P<0.05)；病毒性肝炎患者ANAs阳性组AST、ALT、GGT、TBI均高于阴性组，白蛋白ALB水平低于阴性组，差异均有统计学意义(P<0.01)。病毒性肝炎患者ANAs阳性组IgG高于阴性组，差异均有统计学意义(P<0.01)。

结论

通过检测病毒性肝病患者血清中的多项抗核抗体谱，有助于了解机体的免疫状况，对疾病的临床诊疗和转归具有一定的指导作用。

关键词: 抗核抗体谱, 乙型病毒感染肝炎, 丙型病毒感染肝炎
Objective

The main purpose of this study was to explore clinical significance of serum antinuclear antibody (ANA) profiling in patients with hepatitis B virus (HBV) and hepatitis C virus (HCV) infection, and to provide references for clinical diagnosis and treatment efficacy.

Methods

We retrospectively analyzed the positive rate of ANAs in 1875 cases of HBV, 563 cases of HCV, and 488 healthy controls (HC). Patients with viral hepatitis infection were divided into two subgroups according to ANA results. Demographic data, liver function indexes and immunoglobulin levels of 456 patients were completed collected and analyzed.

Results

The ANA positive rate was 18.40% in HBV patients, 11.90% in HCV patients, and 4.10% in HC patients, and there was a significant difference in ANAs positivity between the viral hepatitis group and healthy controls (P<0.05). The antibodies that showed a significant difference (P<0.05) in the positive rate of ANAs compared with HC in the viral hepatitis group were: anti-dsDNA antibodies, anti-nucleosome antibodies, anti-histone antibodies, anti-SSA/Ro60 antibodies, anti-SSA/Ro52 antibodies, anti-SSB antibody, anti-AMA-M2 antibody, and anti-CENP-B antibody. The most frequent antibody in viral hepatitis was anti-SSA/Ro52 antibody. There were more females in patients with viral hepatitis having ANA positivity (P<0.05). AST, ALT, GGT and TBI were higher in the ANAs-positive group and albumin ALB levels were lower in the negative group, and the differences were significant (P<0.01). The IgG level was significant higher in the ANAs-positive group than in the negative group (P<0.01).

Conclusion

The detection of multiple ANA profiles in the serum of viral liver disease patients helps .to understand the immune status of the organism and has a certain guiding effect on the clinical diagnosis and regression of the disease.

Key words: Antinuclear antibody profile, Hepatitis B virus infection, Hepatitis C virus infection
图1 病毒性肝炎与健康者ANAs抗体分布
表1 乙型肝炎患者和健康者ANA谱抗体比较[例(%)]
组别 例数 ANAs阳性例数(%) dsDNA Nucleosome Histone SmD1 SSA/Ro60 SSA/Ro52 SSB CENP-B Scl-70 U1-snRNP AMA M2
HBV 1875 345(18.4) 107(5.7) 32(1.7) 23(1.2) 6(0.3) 217(11.6) 238(12.7) 98(5.2) 18(1) 5(0.3) 8(0.4) 54(2.9)
HC 488 20(4.1) 0(0) 0(0) 0(0) 0(0) 15(3.1) 19(3.9) 5(1) 1(0.2) 0(0) 0(0) 0(0)
χ2值 ? 60.641 29.169 8.443 6.045 1.566 31.594 30.935 16.401 2.768 1.304 2.09 14.383
P值 ? <0.01 <0.01 <0.01 <0.01 0.356 <0.01 <0.01 <0.01 0.073 0.314 0.157 <0.01
表2 丙型肝炎患者和健康者ANA谱抗体比较[例(%)]
组别 例数 ANA阳性例数(%) DsDNA Nucleosome Histone SSA/Ro60 SSA/Ro52 SSB CENP-B Scl-70 U1-snRNP AMA M2
HCV 563 67(11.9) 13(2.3) 8(1.4) 6(1.1) 45(8) 55(9.8) 13(2.3) 12(2.1) 2(0.4) 2(0.4) 13(2.3)
HC 488 20(4.1) 0(0) 0(0) 0(0) 15(3.1) 19(3.9) 5(1) 1(0.2) 0(0) 0(0) 0(0)
χ2值 ? 19.944 9.597 6.987 5.231 10.855 12.905 1.856 6.443 0.370 0.370 9.597
P值 ? <0.01 <0.01 <0.01 0.033 <0.01 <0.01 0.152 0.04 0.502 0.502 0.02
表3 乙型肝炎患者与丙型肝炎患者ANA与性别的关系[例(%)]
性别 HBV HCV
ANA阳性 ANA阴性 ANA阳性 ANA阴性
男 22(15.19) 1273(84.81) 39(8.92) 398(91.08)
女 117(31.25) 257(68.75) 28(22.22) 98(77.78)
χ2值 50.581 15.251
P值 <0.05 <0.05
表4 病毒性肝炎组和健康组ANA与年龄的关系[±s，岁]
组别 ANA阳性 ANA阴性
例数 年龄 例数 年龄
HBV 345 43.12±14.32 1530 41.23±11.12
HCV 67 39.26±12.35 496 38.23±11.31
HC 20 43.17±9.10 468 41.27±9.37
F值 ? 0.865 ? 0.972
P值 ? >0.05 ? >0.05
表5 病毒性肝炎患者不同ANAs组的肝功能检测结果[±s]
组别 总例数 ALT(U/L) AST(U/L) ALB(g/L) TBI(μmol/L) GGT(U/L) ALP(U/L)
ANAs＋组 78 167.63±87.52 155.62±78.53 30.05±9.11 65.38±30.02 151.27±58.83 110.93±75.86
ANAs-组 378 60.06±42.32 51.06±35.71 35.31±10.23 28.53±19.86 74.56±40.19 96.68±58.32
t值 ? 16.356 18.289 -5.994 13.502 13.964 1.987
P值 ? <0.01 <0.01 <0.01 <0.01 <0.01 0.06
表6 病毒性肝炎患者不同ANAs组的免疫球蛋白检测结果[±s]
组别 总例数 IgG(g/L) IgM(g/L) IgA(g/L)
ANAs＋组 78 15.25±4.54 1.23±0.87 2.75±1.53
ANAs-组 378 12.92±5.25 1.25±0.92 2.78±1.67
t值 ? 3.646 -0.176 -0.146
P值 ? <0.01 0.855 0.884
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