Zusammenfassung
Wir untersuchten mit der direkten Immunfluorescenztechnik die Leberbiopsien von Patienten mit entzündlichen Lebererkrankungen auf intracelluläres HB s Ag, HB c Ag und IgG. Die Untersuchungen haben folgende Ergebnisse erbracht:
1. Klinisch gesunde HB s Ag-Träger hatten in den meisten Fällen HB s Ag im Cytoplasma, jedoch niemals HB c Ag in den Leberzellkernen.
2. Patienten mit HB s Ag-positiver akuter Hepatitis hatten in der Frühphase HB c Ag und/oder HB s Ag in den Hepatocyten. Unsere Befunde sprechen bei normalem Verlauf für eine komplette Immunelimination der HB-Komponenten zu verschiedenen Stadien der Erkrankung mit völliger Wiederherstellung.
3. Kontrollpunktate 1 Jahr nach Beginn einer HB s Ag-positiven Hepatitis zeigten bei völlig gesunden Patienten kein HB s Ag oder HB c Ag. Bei zwei Patienten ohne Immunelimination von HB s Ag entwickelte sich innerhalb eines Jahres eine chronisch aktive Hepatitis. Diese Patienten hatten HB c Ag in den Leberzellkernen.
4. Patienten mit HB s Ag-positiver CAH und Zeichen entzündlicher Aktivität hatten HB c Ag in den Zellkernen und in geringem Prozentsatz HB s Ag im Cytoplasma.
HB s Ag-negative Fälle zeigten niemals HB-Komponenten im Gewebe.
5. In keinem Fall einer HB s Ag-positiven und -negativen CAH in Remission ließ sich HB s Ag und HB c Ag in Hepatocyten nachweisen.
6. In den meisten Fällen von HB s Ag-positiver AH und CAH, die HB c Ag-positiv waren, fand sich in den gleichen Zellkernen IgG. Die strenge Koinzidenz von HB c Ag und IgG läßt an das Vorliegen von anti-HB c in den Zellkernen denken. Die Bedeutung dieses Antikörpers in den Zellkernen für den weiteren Verlauf der Erkrankung ist unbekannt.
Summary
Liver biopsies of patients with inflammatory liver diseases and clinically healthy HB s Ag-carriers were examined for presence of intracellular HB s Ag, HB c Ag and IgG by direct immunofluorescence. The studies revealed the following results:
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1.
In most cases healthy HB s Ag-carriers had HB s Ag in the cytoplasm, but they did never show HB c Ag in the nuclei of hepatocytes.
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2.
In the early phase some patients with HB s Ag-positive acute hepatitis had HB c Ag and/or HB s Ag in their hepatocytes. In a normal course with complete recovery the immunoelimination may clear either phenomenon at variable stages of the disease.
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3.
Cases one year after complete recovery of acute virus B-hepatitis had no HB-components in their liver tissue. 2 cases without immunoelimination of HB s Ag developed chronic active hepatitis within one year and had HB c Ag in their liver cell nuclei.
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4.
Patients with HB s Ag-positive CAH and highly inflammatory activity had HB c Ag in the nuclei and a low percentage of cells with HB s Ag in the cytoplasm of hepatocytes. HB s Ag-negative cases with CAH never had HB-components in their tissue.
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5.
Patients with HB s Ag-positive and -negative CAH in complete remission never had HB c Ag and HB s Ag in their hepatocytes.
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6.
Most cases with HB s Ag-positive acute hepatitis and chronic active hepatitis positive for HB c Ag had also IgG in the same liver cell nuclei. The coincidence of this finding gives strong evidence for the presence of anti-HB c in these liver cell nuclei. The importance of this finding for the course of the disease is unknown.
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This work was supported by the Deutsche Forschungsgemeinschaft, ‘Sonderforschungsbereich’ 107 and Ar 106/1, Me 244/8 and 9, Mainz.
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Arnold, W., Meyer zum Büschenfelde, K.H., Hess, G. et al. The diagnostic significance of intrahepatocellular hepatitis-B-surface-antigen (HB s Ag), hepatitis-B-core-antigen (HB c Ag) and IgG for the classification of inflammatory liver diseases. Klin Wochenschr 53, 1069–1074 (1975). https://doi.org/10.1007/BF01614383
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DOI: https://doi.org/10.1007/BF01614383
Schlüsselwörter
- Hepatitis-B-core-Antigen
- Hepatitis-B-surface-Antigen
- akute Hepatitis
- chronisch aktive Hepatitis
- gesunde HB s Ag-Träger
- Leberbiopsie
- fluorescierende Antikörpertechnik