Clinical and immunological findings in hepatitis B antigen-positive and hepatitis B antigen-negative chronic active hepatitis.

The clinical, biochemical and immunological data of 24 hepatitis B antigen-positive and 24 hepatitis B antigen-negative patients have been compared. In B antigen-positive hepatitis, being mostly the disease of males, an acute onset was frequent and perceivable cirrhosis at the time of diagnosis not frequent. In B antigen-negative chronic active hepatitis, in addition to the predominance of females, a "primary chronic" process, cirrhosis, elevated ESR, immunocytopenia, elevated alkaline phosphatase and IgG levels were more frequent. As regards the positivity of humoral and cellular autoimmune reactions and the impairment of normal cellular immune activity, no essential differences were found between the two forms of the disease. It is concluded that though the two clinical conditions represent diseases different in aetiology and manifesting with certain clinical and biochemical differences the role of immunological factors may equally be important in their pathogenesis.

Low activity of the classical complement pathway predicts short survival of patients with chronic lymphocytic leukaemia.

The activities of the classical (CP) and alternative (AP) complement pathways as well as the levels of some complement components and circulating immune complexes were measured in 43 patients with chronic lymphocytic leukaemia (CLL) between 1980 and 1984. Depressed CP activities were frequently found in these patients. Clinical course of the disease in the patients was followed until 1992, and compared with the initial complement values. During the follow-up period 36 patients died, death of 33 patients being related to the underlying disease. A strong positive correlation (P < 0.01) was found between the length of survival of the patients and the initial CP values. Patients were divided into two groups: group A, short-term survivors, i.e patients who died in CLL-related complications within 3 years after the complement measurements; and group B, long-term survivors who died > or = 4 years after the complement measurements due to any cause, or were alive at the end of the follow-up period. Average CP values in Group B were almost twice those in group A (P = 0.002), and a similar but less pronounced difference was found in C3 levels (P = 0.055). These differences were even more marked (P = 0.0006 and P = 0.0015, respectively) when only patients in Rai stage 2 and 3 were considered. Low classical pathway activities predicted short survival time: according to the logrank test, patients in Rai stage 2-3 with low (< mean - 2s.d. of the normal values), and normal CP levels survived for 2.0 +/- 1.1, and 4.6 +/- 3.0 years, respectively. All the nine and 11/13 patients with low CP and C4 levels, respectively, died within 3 years after the complement measurements were made. These findings indicate that complement measurements performed in CLL patients have a clinical value.

Repressed classical complement pathway activities and clinical correlations in chronic lymphocytic leukaemia.

Haemolytic activities of the classical and alternative complement pathways, and levels of C1, C4, C3, factor B and C1 inhibitor (C1-INH) were measured in 137 serum samples of 69 patients with chronic lymphocytic leukaemia (CLL). In most sera IgG, IgA and IgM concentrations were determined as well. Clinical correlations of these laboratory parameters have been studied. C1 and C4 activities were found to be depressed in almost 50% of the sera tested, and hypogammaglobulinaemia was observed with a similar frequency. Low C1 and C4 levels were found mainly in the early stages of the disease. A strong association between the occurrence of infections and hypogammaglobulinaemia was observed, although low immunoglobulin levels frequently occurred in patients without a history of infections. Low C1 and C4 levels were significantly correlated with the incidence of infections, too, and this correlation was observed mostly in the early stages of the disease. The reason for this is not known. The present results suggest that not only low immunoglobulin levels but low C1 and/or C4 levels may contribute to the increased susceptibility to infections in patients with chronic lymphocytic leukaemia.