目的探讨dsDNA抗体对自身免疫性肝炎(autoimmune hepatitis,AIH)的临床意义。方法收集临床诊断为AIH的患者血清43例,采用免疫印迹法检测dsDNA抗体。按dsDNA抗体阳性与否,分为抗体阳性组及抗体阴性组,比较dsDNA抗体阳性组与阴性组临床生化指标及预后的差异。结果43例AIH患者中dsDNA抗体阳性13例(30.23%)。13例dsDNA抗体阳性AIH患者平均天冬氨酸转氨酶(AST)为(647.56±529.77)IU/ml,总胆红素(TBIL)为(10.81±8.08)mg/L,明显高于对照组(P〈0.05),凝血酶原活动度(PTA)为75.72%±30.23%,明显低于对照组(P〈0.05)。dsDNA抗体阳性AIH患者组肝硬化发生率为61.5%(8/13),明显高于对照组(P〈0.05)。对两组患者出现肝硬化的时间作生存分析,发现dsDNA抗体阳性AIH患者发生肝硬化的时间明显短于对照组(P=0.0074)。结论抗dsDNA阳性的AIH患者肝损伤较重,病情进展较迅速,预后较差。
Objective To study the significance of antibody to double-stranded DNA (anti- dsDNA) in autoimmune hepatitis(AIH). Methods Anti-dsDNA were detected by immunological blotting. According to the anti-dsDNA, the patients were separated two groups: anti-dsDNA positive group and anti-dsDNA negative group. The clinical characteristics were compared between anti-dsDNA positive AIH group and negative group. Results Among the 43 serum samples, 13 (30.23%) cases with anti-dsDNA positive were found. The average level of AST( aspartate aminotransferase) and TBIL( total bilirubin) were (647.56±529.77) IU/L and ( 10.81±8.08) mg/L, respectively, which was higher than that of the control group ( P〈0.05 ). PTA( prothrombin activity) was 75.72% ±30.23%, lower than that of the control group( P〈0.05). The liver cirrhosis rate in the anti-dsDNA positive AIH group was 61.5% (8/13),significantly higher than that of the control group. The time from the onset to liver cirrhosis was significantly shorter in anti-dsDNA positive AIH group than that of control group by the survival analysis and log rank test ( P=0.0074). Conclusion AIH patients with anti-dsDNA positive generally associate with the serious liver damage, and prognosis is worse.