论文部分内容阅读
目的:探讨中国西部自身免疫性肝病患者中相关自身抗体的存在状况及特征。方法:57例自身免疫性肝病患者分为3组:自身免疫性肝炎(AIH)12例、原发性胆汁性肝硬化(PBC)32例、原发性硬化性胆管炎(PSC)13例。用间接免疫荧光法检测抗核抗体(ANA)、平滑肌抗体(SMA)、抗肝肾微粒抗体1型抗体(anti-LKM1)、抗线粒体抗体(AMA)和抗中性粒细胞胞质抗体(ANCA),Western blot检测抗肝细胞胞溶质抗原1型抗体(anti-LC1)、抗可溶性肝抗原/肝胰抗原抗体(anti-SLA/LP)、抗肝肾微粒抗体1型(anti-LKM1)、AMA-M2亚型等多种肝抗原自身抗体。结果:57例中ANA、AMA、M-2、pANCA阳性率在组间有统计学差异(P<0.01)。PBC中AMA、M-2阳性检出率均为100%,PSC中pANCA阳性检出率为53.8%,Fisher精确检验在α’=0.002水准与其他各组比较有统计学差异。AIH与PBC的ANA阳性率分别为100%和50%,Fisher精确检验在α’=0.002水准二者无统计学意义,与其他各组比较有明显差异。在AIH组SMA阳性率为25%,LKM-1、LC-1、SLA/LP阳性率均为8.3%,与其他组无统计学意义,可能与病例少有关。PBC中分别有1例患者ANA、SMA以及ANA、LKM-1同时阳性,PSC中有1例ANA、SLA/LP同时阳性,此3例患者结合性别、生化、自身抗体等资料符合AIH诊断条件;AIH中有1例M-2阳性综合各项资料符合PBC(重叠综合征)。结论:肝抗原自身抗体、ANA、AMA及M-2亚型的检测有助于自身免疫性肝病的诊断。对肝炎病毒血清标志物阴性的肝功能异常者应该行肝抗原自身抗体检测协助诊断。
Objective: To investigate the status and characteristics of related autoantibodies in patients with autoimmune liver disease in western China. Methods: Fifty-seven patients with autoimmune liver disease were divided into three groups: 12 cases of autoimmune hepatitis (AIH), 32 cases of primary biliary cirrhosis (PBC) and 13 cases of primary sclerosing cholangitis (PSC). ANA, SMA, anti-LKM1, anti-mitochondrial antibody (AMA) and anti-neutrophil cytoplasmic antibody (ANCA) were detected by indirect immunofluorescence assay Western blot was used to detect anti-LC1, anti-SLA / LP, anti-LKM1, AMA-M2 subtype and many other liver antigen autoantibodies. Results: The positive rates of ANA, AMA, M-2 and pANCA in 57 cases were statistically different between the two groups (P <0.01). PBC AMA, M-2 positive detection rate was 100%, PSC pANCA positive detection rate was 53.8%, Fisher exact test in α ’= 0.002 level compared with the other groups were statistically significant. The positive rates of ANA in AIH and PBC were 100% and 50%, respectively. There was no significant difference between Fisher’s exact test and α ’= 0.002, which was significantly different from other groups. In AIH group, the positive rate of SMA was 25%, the positive rate of LKM-1, LC-1 and SLA / LP was 8.3%, which was not statistically significant with other groups. One case of PBC had positive ANA, SMA, ANA and LKM-1, and one case of ANA in PSC. SLA / LP were positive at the same time. The data of three patients were gender, biochemical and autoantibody conformed to AIH diagnostic criteria. One AI-positive M-2 positive data complied with PBC (Overlap Syndrome). Conclusion: The detection of autoantibodies to liver antigens, ANA, AMA and M-2 is helpful for the diagnosis of autoimmune liver disease. Hepatitis A virus serum markers negative liver dysfunction should be detected by autoantibodies against liver antigens to help diagnose.