doiSerbia

Udeo autoantitela karakterističnih za autoimuni hepatitis u hroničnom hepatitisu C

Pavić Slađana (Infektivno odeljenje Opšte bolnice, Užice)
Simonović Jasmina (Institut za infektivne bolesti, Klinički centar Srbije, Beograd)
Boričić Ivan V. (Institut za patologiju, Medicinski fakultet, Beograd)
Švirtlih Neda (Institut za infektivne bolesti, Klinički centar Srbije, Beograd)

In the patients with chronic hepatitis C (HHC) there have been found different autoantibodies, some typical for autoimmune hepatitis (AIH) type 1, like: antinuclear antibodies (ANA) in 15-60%, anti-smooth muscle antibodies (ASMA) in 34-60%, or AIH type 2: anti liver/kidney microsomes 1 autoantibodies (LKM 1) in 0-6%. Also, antimitochond-rial autoantibodies (AMA), which defines PBC, is discovered in 0.7-1.5% patients with HHC. The purpose of the research was to determine the titr of the serum autoatibodies, which characterize AIH in the patients with HHC and to compare demographical, clinical, biochemical, histological and immunological parameters in the groups of patients: with or without autoantibodies. In 50 patients with HHC are defined clinical (demographical, troubles) facts laboratorial (the values of complete bilirubin, ALT), histological diagnosis of the liver tissue (PH), and virusological diagnosis (antibodies and antigens of the hepatitis C virus), immunological (autoantibodies immunoglobulins). The analysis of the results show us that ANA and AMA haven't been present in the patients with HHC in considerable titr (>1:80) while in 10% of the patients there have been titr of ASMA. In 2 patients were both titrs, ANA (1:40) and ASMA (1:40), as well, wich considered important, so there is entirely 7 patients (14%) with detected ANA and ASMA in considerable titr. Autoantibodies, which are characteristic for AIH 2 have not been found in the patients with HHC. Considered the sex, between the group of patients with HHC and autoantibodies, and the group of patients with HHC without autoantibodies, there is no important difference, althoug the percent of male is a little bit bigger in the second group. Considering the growth, there were no important difference between the patients groups. The fact that appearance of autoatibodies has no correlation with the growth, we can explain with the fact that she most of patients with HHC are persons from 21 to 30 years old, and that the older are no so present. The troubles are present in about the half patients with HHC, and it isn't proved that the appearance of autoantibodies have the influence on this particular clinical parameter. The comparison of activities of the disease the analysis of the ALT values and the bilirubin, we also didn't get considerable difference beetwen these two groups of patients. Three patients who haven't autoantibodies, but they have the ALT values expended between 5 and 10 times, which we consider the high grade of the necrosis. This high values we can't notice in the patients with autoantibodies. The parameters of grade inflamatory reactions of the extent values of Ig, so as IgG category, also doesn't show we the important difference beetwen the groups. The most patients have normal values both: Ig and IgG. Despite that in both categories of the patients, there is no considerable difference in PH, as well as, in the stage of fibrosis, two patients without autoantibodies have more visible degree of necrosis, manifested like reasonable necrosis, while all the others patients have gently visible necrosis. It is important to say that the patients with autoantibodies have no histological indications for AIH, in the PH sense, and the presence of more important plasmatic infiltrat. All the patients with HHC and autoantibodies have higher values CIC, but the freqvency of appereance is not different between the both groups, which show us the variety of becaming autoimmunes and immunes phenomena in HHC. Based on produced results, we can conclude that: 1. autoantibodies which are characteristic for AIH 1 are visible in 14% of the HHC patients, 2. there are more ASMA in HHC, then ANA; 3. there is no autoantibodies, which characterize AIH 2, in HHC; 4. the growth and the sex of the patients with HHC have no influence on showing autoantibodies characteristic for AIH; 5. the presence of autoantibodies, characteristic for AIH 1, have no importance of showing the burdens in the patients, degree of PH and the stadium of the diseases, and also on the value of Ig and IgG; 6. discovering the autoantibodies in HHC, no matter there is no considerable presence on it's simptomatology and the prognosis, oblige us on further following and analysis for starting antivirus therapy, in order to present eventual beginning of AIH.

Keywords: chronic hepatitis, hepatitis C virus, autoantibodies