Autoantibodies in chronic hepatitis C virus infection: impact on clinical outcomes and extrahepatic manifestations.
Autoantibodies in chronic hepatitis C virus infection: impact on clinical outcomes and extrahepatic manifestations.
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DOI：
10.1136/bmjgast-2018-000203
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发表时间：
2018
影响因子：
3.1
通讯作者：
Nguyen MH
中科院分区：
文献类型：
--
作者：
Gilman AJ;Le AK;Zhao C;Hoang J;Yasukawa LA;Weber SC;Vierling JM;Nguyen MH
研究自身抗体(自身抗体)在慢性丙型肝炎病毒(丙型肝炎病毒)中所起的作用，包括人口学特征、肝外表现和长期预后。据报道，自身抗体在慢性丙型肝炎患者中很普遍，但关于这些患者自然病史的数据有限。1556例无HIV和/或乙肝病毒感染的丙型肝炎患者进行了抗核抗体(ANA)、抗线粒体抗体(AMA)、抗平滑肌抗体(ASMA)和/或抗肝肾微粒体抗体(LKM)检测。主要结果包括发展为肝硬变、肝脏失代偿、肝细胞癌、死亡率和/或抗病毒治疗的持续病毒学应答(SVR)。共有388名患者检测出任何自动抗体阳性(ANA 21.8%、ASMA 13.3%、AMA 2.2%和LKM 1.2%)。检测阳性与阴性的患者更有可能是女性(29.3%比20.9%，p<；0.001)，而大多数接受干扰素治疗的患者实现SVR的可能性较小(37.2%比47.1%，p=0.031)。两组在基础实验室数据、疾病状态或肝外症状发生率方面无差异(42.8%比45.0%，p=0.44)。Kaplan-Meier分析显示，两组之间在10年发展为肝硬变、肝脏失代偿、肝细胞癌和生存期方面没有统计学意义上的差异。此外，多因素分析显示，自身抗体阳性仅是低SVR发生率的预测因子(调整后OR=1.61，95% 可信区间为1.00~2.58，p=0.048)。在我们的队列中，Auto-ab阳性很常见，尤其是在女性中，这预示着SVR的发生率较低，但其他方面对慢性丙型肝炎的自然病史或肝外表现没有影响。
To examine the role that autoantibodies (auto-abs) play in chronic hepatitis C virus (HCV) regarding demographics, presence of extrahepatic manifestations and long-term outcomes in a large US cohort. Auto-abs have been reported to be prevalent in patients with chronic HCV infection, but data on the natural history of these patients are limited. The study included 1556 consecutive patients with HCV without concurrent HIV and/or HBV who had testing for antinuclear antibody (ANA), antimitochondrial antibody (AMA), antismooth muscle antibody (ASMA) and/or antiliver kidney microsomal antibody (LKM). Primary outcomes included development of cirrhosis, hepatic decompensations, hepatocellular carcinoma (HCC), mortality and/or sustained virological response (SVR) to antiviral therapy. A total of 388 patients tested positive for any auto-ab (ANA 21.8%, ASMA 13.3%, AMA 2.2% and LKM 1.2%). Patients who tested positive versus negative were more likely to be women (29.3% vs 20.9%, p<0.001) and less likely to achieve SVR with most treated patients receiving interferon-based therapies (37.2% vs 47.1%, p=0.031). There was no difference between groups for baseline laboratory data, disease state or rate of extrahepatic manifestations (42.8% vs 45.0%, p=0.44). Kaplan-Meier analysis revealed no statistically significant difference between groups for the 10-year development of cirrhosis, hepatic decompensations, HCC nor survival. Furthermore, auto-ab positivity was only found to be a predictor for a lower rate of SVR on multivariate analysis (adjusted OR=1.61, 95 % CI 1.00 to 2.58, p=0.048). In our cohort, auto-ab positivity was common, especially in women, and predicted a lower rate of SVR but otherwise had no impact on the natural history of chronic HCV or presence of extrahepatic manifestations.
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