【摘要】 前言抗中性粒细胞胞浆抗体(ANCA)是针对中性粒细胞胞浆成份产生的一类自身抗体。分为二型:胞浆型(C-ANCA)和核周型(P-ANCA);C-ANCA主要识别靶抗原蛋白酶3(PR3),P-ANCA主要识别髓过氧化物酶(MPO);已证实ANCA与原发性小血管炎密切相关,为这些疾病的重要血清学诊断指标。病毒性肝炎(以下简称肝炎)是我国发病率较高的一组疾病,病原主要为肝炎病毒。目前发现肝炎病毒可能是触发自身免疫的因素之一,自身免疫性肝炎和某些肝炎病毒的感染相关;另外,在病毒性肝炎中发现许多自身抗体,尤其是在丙型肝炎中检测到ANCA,但其临床意义不清。目的初步探讨ANCA在病毒性肝炎中的检测及临床意义,同时检测ANA,作为ANCA的对照指标。方法用间接免疫荧光方法(IIF)和酶联免疫吸附技术(ELISA)检测204例肝炎患者血清中ANCA和ANA。结果58例正常献血员ANCA均阴性。甲型肝炎中ANCA阳性率为10.2％(4/39),乙型肝炎19％(20/105),丙型肝炎为25％(10/40),戊型肝炎为15％(3/20)。ANCA在各型肝炎中阳性率无显著性差异(P>0.05)。甲型肝炎急性期和恢复期ANCA阳性率亦无显著性差异(P>0.05)。乙型肝炎中急性乙肝、慢性乙肝及乙肝后肝硬化三组之间ANCA阳性率也无差异(P>0.05)。各型肝炎中阳性ANCA均为C-ANCA。我们还用IIF法检测各型肝炎中ANA的阳性率,甲型肝炎中ANA阳性率为7.7％(3/39),乙型肝炎为21％(22/105),丙型肝炎为20％(8/40),戊型肝炎10％(2/20)。甲型肝炎急性和恢复期ANA的阳性率无显著性差异(P>0.05)。乙肝三组ANA的阳性率亦无显著性差异(P>0.05)。各型肝炎中ANCA和ANA无相关性(P>0.05),显示了ANCA和ANA分别为病毒性肝炎中两种独立的自身抗体。结论研究显示在各型病毒性肝炎中均检测出ANCA,其阳性率较低;初步认为ANCA与病毒性肝炎可能有关;ANCA与ANA分别为病毒性肝炎中两种独立的自身抗体,进一步反映了病毒性肝炎中存在自身免疫现象。ANCA在病毒性肝炎中的临床意义尚不清楚,需要进一步研究及探讨。更多还原

【Abstract】 Objective To investigate the relationship between ANCA and viral hepatitis. Methods Standard indirect immunofluorescence (IIF) test and enzyme linked immunosorbent assay were used to detect serum ANCA and ANA of all 204 patients with hepatitis. Results ANCA was negative in 58 healthy donors, but positive in 10.2%(4/39), 19%(20/105), 25%(10/40) and 15%(3/20) of patients with viral hepatitis A(VHA), viral hepatitis B (VHB), viral hepatitis C (VHC) and viral hepatitis E (VHE), respectirely. Also we have investigated positive rate of ANCA in patients with different period of viral hepatitis A, including acute and recovery stages. They had no difference (P>0.05). We also divided viral hepatitis B into three groups: acute viral hepatitis, chronic hepatitis and cirrhosis. They were compared with each other about ANCA positive rate and no difference existed (P>0.05). The pattern of all positive ANCA was C-ANCA. By IIF we detected ANA in the same samples. ANA was positive in 7.7%, 21%, 20% and 10% of patients with VHA, VHB, VHC and VHE, respectively. There was no difference about ANA positive rate between acute and recovery stage in viral hepatitis A (P>0.05). ANA positive rate was no difference among three groups of viral hepatitis B. We also compared ANCA positive rate with ANA. The results show that ANCA does not relate with ANA and they are two independent autoantibodies (P>0.05). Conclusions ANCA is detected in patients with viral hepatitis A、B、C、E and the positive rate is lower. ANCA and ANA are two kinds of independent autoantibodies. The results above further show thai autoimmunity exists in viral hepatitis. But the significance of ANCA in viral hepatitis is still not clear and require further to investigate.更多还原