Studies on autoimmune hepatitis type I,II,and III

最近，针对肝病的自身抗体被鉴定出来，欧洲研究人员试图根据自身抗体将自身免疫性肝炎(AIH)分为4组。本研究的目的是探讨日本慢性肝病患者血清中抗肝/肾微粒体1型抗体(抗LKM1)的频率及其意义。抗LKM1阳性的6例患者均为成人，病程长(2~8年)。其中三人患有慢性甲状腺炎。与50例抗-LKM1阴性的慢性丙型肝炎患者相比，年龄、性别比及实验室检查结果均无明显差异。5例患者中有3例对干扰素治疗反应良好。这些发现提示，我们的6例患者应被诊断为抗LKM1或AIH IIb型抗-LKM1阳性的慢性丙型肝炎。本研究未发现抗LKM1阳性的AIH患者，表明AIH IIa型在日本非常罕见。2.在358例慢性肝病患者中有2例发现抗SLA抗体，提示AIH III型在日本一定非常罕见。其中1例诊断为AIH，1例诊断为慢性丙型肝炎。3.在358例患者中，16例SMA高滴度阳性的慢性肝炎患者的血清稀释度超过1：160。部分患者有较高的血清丙种球蛋白血症。有趣的是，10%的慢性非甲、乙、丙型肝炎患者SMA呈索氏阳性，这些患者似乎是AIH III型。

Recently autoantibodies specific for liver diseases are identified and European investigators attempted to classify autoimmune hepatitis (AIH) into 4 groups by autoantibodies. The aims of present study are to investigate the frequency and significance of seropositivity of such autoantibodies in Japanese patients with chronic liver diseases.1.Antibodies to liver/kidney microsomal type 1 (anti-LKM1) which were proposed as a maker of AIH type II were found in 2.5% of patients with chronic hepatitis C,but not in other patients including autoimmune hepatitis. All 6 patients positive for anti-LKM1 were adults, and had a long duration of illness (range, 2 to 8 years). Three of them had chronic thyroiditis. There were no obvious difference in age, sex ratio and laboratory findings comparing to those with 50 patients with chronic hepatitis C negative for anti-LKM1. Three of 5 patients responded well to interferon alpha therapy. Those findings suggest that our 6 patients should be diagnosed as chronic hepatitis C positive for anti-LKM1 or AIH type IIb. No patients of AIH positive for anti-LKM1 were found in the present, study, indicating that AIH type IIa is very rare in Japan.2.Antibodies to soluble liver antigens (anti-SLA) were found in 2 out of 358 patients with chronic liver disease, suggesting that AIH type III must be very rare in Japan. One was diagnosed as AIH and the other one was diagnosed as chronic hepatitis C.It would be of interest to follow up these 2 patients.3.Patients with chronic hepatitis positive for high titers of SMA more than 1 : 160 dilution were found in 16 out of 358 patients. Some of them have high serum gamma-globulinemia. Interestingly, 10% of chronic hepatitis non A,B and C were soropositive for SMA.Those patients seem to be AIH type III.