苗霞

[摘要] 目的 探讨乙型病毒性肝炎患者的发病与抗心磷脂抗体（ACA）相关性，以更好地为乙型肝炎的临床诊断、治疗及预后判断提供支持。 方法 选择2005年7月～2013年12月来我院传染科就诊的226例乙型病毒性肝炎患者为研究对象，按照2000年9月全国第十次病毒性肝炎及肝病学术会议（西安）修订的《病毒性肝炎防治方案》标准分为急性病毒性肝炎患者、慢性病毒性肝炎患者、淤胆型病毒性肝炎患者、重型病毒性肝炎患者、肝硬化患者5组，另选择健康查体者118例作为正常对照组，采用ELISA法对所有被检者进行ACA检测，计算各组ACA阳性率。 结果 乙型病毒性肝炎ACA-IgG和ACA-IgM阳性率显著高于正常对照组（P<0.01），重型肝炎和肝炎后肝硬化组ACA-IgG和ACA-IgM阳性率比较，差异无统计学意义（P>0.05），两项指标与慢性肝炎组患者比较，差异有统计学意义（P<0.05），与淤胆型肝炎患者和急性肝炎患者比较，差异有统计学意义（P<0.01）；在治疗后最终死亡的重型肝炎患者中，ACA阳性率高达94.4%，明显高于76.9%的最终存活者，差异有统计学意义（P<0.05）；慢性肝炎的63例患者，44例ACA阳性患者中有11例患者在15～36个月演变为肝硬化，19例ACA阴性患者未出现肝硬化。 结论 ACA阳性例数在乙型肝炎患者中明显增加，表明ACA参与了乙型病毒性肝炎的发病，应对ACA追踪检测，ACA对慢性肝炎是否会进一步演变为肝硬化有预测价值。

[关键词] 抗心磷脂抗体；病毒；乙型病毒性肝炎

[中图分类号] R512.6+2 [文献标识码] A [文章编号] 1674-4721（2015）08（c）-0129-03

[Abstract] Objective To explore the correlations between the occurrence of viral hepatitis B and anticardiolipin antibody（ACA），so as to better provide supports for the clinical diagnosis，treatment and prognosis judgment of hepatitis B. Methods 226 patients with viral hepatitis B who visited the department of infectious diseases in our hospital from July 2005 to December 2013 were selected as research subjects.They were assigned into five groups，including patients with acute viral hepatitis，patients with chronic viral hepatitis，patients with cholestatic viral hepatitis，patients with severe viral hepatitis and patients with liver cirrhosis according to the edited in the Tenth National Academic Conference of Viral Hepatitis and Hepatic Diseases （Xi′an） held in September 2000.118 healthy persons were selected as normal control group.ELISA method was applied to perform ACA test for all testees， and ACA positive rate in each group was calculated. Results Positive rates of ACA-IgG and ACA-IgM in hepatitis B were significantly higher than those in the healthy control group （P<0.01）.Positive rates of ACA-IgG and ACA-IgM compared between the groups of severe hepatitis and post-hepatitis cirrhosis were not significantly different （P>0.05）.The two indices were significantly different compared to those in the patients with chronic hepatitis（P<0.05），and were extremely significantly different compared to those in the patients with cholestatic hepatitis and patients with acture hepatitis（P<0.01）； among the patients with severe hepatitis who were deceased after the treatment，the ACA positive rate was as high as 94.4%，significantly higher than that of 76.9% in the survivors，and there was a significant difference between the two （P<0.05）；Among 63 patients with chronic hepatitis，11 in 44 patients with positive ACA turned to cirrhosis in 15-36 months， and 19 patients with negative ACA did not have cirrhosis. Conclusion The number of patients with positive ACA significantly increases in the patients with hepatitis B，indicating that ACA is involved in the occurrence of hepatitis B，so ACA should be traced；ACA has predictive value in whether chronic hepatitis will further develop into hepatic cirrhosis.

[Key words] Anticardiolipin antibody（ACA）；Virus；Viral hepatitis B

目前认为乙型病毒性肝炎的发病机制为乙肝病毒入侵人体后，从人体的肝细胞摄取养料生存，并反复进行复制。肝细胞膜上的表面抗原、e抗原等通过激发人体的免疫系统使得机体发生一系列的免疫反应[1]。抗心磷脂抗体（anticardiolipin antibody，ACA）作为人体的一种自身抗体，通过与心磷脂-蛋白复合物结合，干扰依赖磷脂的凝血和抗凝因子发挥作用，从而促进血栓形成[2]。ACA是如何通过乙型肝炎病毒（HBV）的作用诱发肝炎的发生，及乙型肝炎各型之间与ACA的演变，国内外报道很少。本文通过检测肝炎患者血清中的ACA，探讨ACA在乙型肝炎中的作用，寻求乙型肝炎的发病机制，以更好地为乙型肝炎患者诊断、治疗和预后判断提供实验支持。……