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目的检测慢性乙型肝炎儿童自身抗体的阳性率,探讨其自身抗体存在的临床意义。方法采用间接免疫荧光法检测84例慢性乙型肝炎儿童、69例慢性乙型肝炎成人和15例正常儿童抗核抗体(ANA)的阳性率、滴度、核型和抗平滑肌抗体(SMA)、抗线粒体抗体(AMA)、抗肝肾微粒体抗体(LKM)、抗胃壁细胞抗体(APCA)的阳性率。同时检测患者的ALT、AST,对慢性乙型肝炎儿童取肝活检组织作病理组织学检查。结果 (1)慢性乙型肝炎儿童组总自身抗体阳性率为19.0%,较成人慢性乙型肝炎患者组为低(P<0.05)。(2)慢性乙型肝炎儿童组检出的ANA以低滴度(1:100)为主,有3例滴度为1:320;ANA核型全部为均质型;仅有1例SMA阳性,未见其他自身抗体阳性。(3)慢性乙型肝炎儿童自身抗体阳性组的ALT、AST水平均高于自身抗体阴性组(P<0.05)。(4)慢性乙型肝炎儿童自身抗体阳性组肝脏病理G>2者占43.8%,较自身抗体阴性组G>2者(16.2%)比例明显增高,差异有统计学意义(P<0.05)。结论慢性乙型肝炎儿童中也有一定比例存在自身抗体,但较成人慢性乙型肝炎患者为低。自身抗体的产生与肝损伤程度有一定相关性,检测慢性乙型肝炎儿童自身抗体对选择抗病毒治疗方案有一定的指导意义。
Objective To detect the positive rate of autoantibodies in children with chronic hepatitis B and to explore the clinical significance of their autoantibodies. Methods The positive rates, titers, karyotypes and anti-smooth muscle antibodies (ANA) of 84 children with chronic hepatitis B, 69 children with chronic hepatitis B and 15 normal children were detected by indirect immunofluorescence. Anti-mitochondrial antibody (AMA), anti-liver and kidney microsomal antibody (LKM), anti-parietal cell antibody (APCA) positive rate. At the same time, the patients’ ALT and AST were detected, and the biopsy tissues of children with chronic hepatitis B were taken for histopathological examination. Results (1) The positive rate of total autoantibodies in children with chronic hepatitis B was 19.0%, which was lower than that of adult patients with chronic hepatitis B (P <0.05). (2) ANA detected in children with chronic hepatitis B was mainly low titer (1: 100), with 3 titers of 1: 320; ANA karyotypes were all homogeneous; only 1 SMA was positive , No other autoantibody positive. (3) The levels of ALT and AST in autoantibodies positive children with chronic hepatitis B were higher than those with autoantibodies negative (P <0.05). (4) The positive rate of G> 2 in CHB children was 43.8%, which was significantly higher than that of G> 2 (16.2%) in autoantibodies negative group (P <0.05). Conclusions There is also a certain proportion of autoantibodies in children with chronic hepatitis B, but lower than those in adults with chronic hepatitis B. The production of autoantibodies and liver injury have a certain degree of correlation, detection of autoantibodies in children with chronic hepatitis B on the choice of anti-viral treatment program has some guiding significance.