论文部分内容阅读
目的:分析各种肝病患者多种自身抗体的检出率,探讨其对自身免疫性肝病(autoimmune liver diseases,ALD)的诊断价值。方法:根据临床诊断将患者分为ALD组(n=96)、病毒性肝炎组(n=135,包括75例乙型肝炎,65例丙型肝炎),另取62例健康体检者作为健康对照组(n=62);其中,ALD组又分为自身免疫性肝炎组(AIH组,n=36)、原发性胆汁性肝硬化组(PBC组,n=58)、原发性硬化性胆管炎组(PSC组,n=2)。用间接免疫荧光法检测上述各组的抗核抗体(antinuclear antibodies,ANA)、抗平滑肌抗体(anti-smooth muscle antibodies,ASMA)、抗线粒体抗体(antimitochondrial ant-ibodies,AMA);用Western印迹法检测抗肝肾微粒体Ⅰ型抗体(anti liver-kidney microsomal antibody Type 1,LKM-1)和抗线粒体Ⅱ型抗体(subtype of AMA,AMA-M2)、抗可溶性肝抗原/胰抗原抗体(soluble liver antigen/liver pancreas,SLA/LP)、抗肝细胞溶质抗原Ⅰ型抗体(antihepatocyte cytosol antigen Type 1,LC-1)。结果:AIH组ANA阳性率(69.4%)和PBC组ANA阳性率(87.9%)显著高于病毒性肝炎组(37.3%)和健康对照组(4.8%)(均P<0.01);AIH组ASMA,LKM-1,SLA/LP,LC-1阳性率(44.4%,11.1%,2.8%,8.3%)显著高于病毒性肝炎组(1.3%,1.7%,0,0)和健康对照组(均P<0.01);PBC组AMA-M2阳性率(91.3%)显著高于病毒性肝炎组(1.3%)和健康对照组(0)(均P<0.01)。结论:联合检测ANA,ASMA,LKM-1,SLA/LP,LC-1和AMA-M2等自身抗体可提高ALD诊断的灵敏性和特异性,且对ALD分型、诊疗具有重要意义。
OBJECTIVE: To analyze the detection rate of multiple autoantibodies in various liver diseases and to explore its diagnostic value in autoimmune liver diseases (ALD). Methods: According to clinical diagnosis, patients were divided into ALD group (n = 96), viral hepatitis group (n = 135, including 75 hepatitis B patients and 65 hepatitis C patients), and another 62 healthy subjects were selected as healthy controls (N = 62). The ALD group was divided into three groups: autoimmune hepatitis (AIH group, n = 36), primary biliary cirrhosis group (PBC group, n = 58), primary sclerosis Cholangitis group (PSC group, n = 2). The anti-smooth muscle antibodies (ASMA) and antimitochondrial anti-ibodies (AMA) of the above groups were detected by indirect immunofluorescence. Anti-liver-kidney microsomal antibody type 1 (LKM-1) and subtype of AMA (AMA-M2), anti-soluble liver antigen / liver pancreas, SLA / LP), antihepatocyte cytosol antigen type 1 (LC-1). Results: The positive rate of ANA in AIH group (69.4%) and ANA positive group (87.9%) in PBC group was significantly higher than that in viral hepatitis group (37.3%) and healthy control group (4.8% (44.4%, 11.1%, 2.8%, 8.3%) of LKM-1, SLA / LP and LC-1 were significantly higher than those of viral hepatitis group (1.3%, 1.7%, 0,0) and healthy control group (P <0.01). The positive rate of AMA-M2 in PBC group (91.3%) was significantly higher than that in viral hepatitis group (1.3%) and healthy control group (P <0.01) Conclusion: The combined detection of autoantibodies such as ANA, ASMA, LKM-1, SLA / LP, LC-1 and AMA-M2 can improve the sensitivity and specificity of ALD diagnosis and is of great significance for the typing and diagnosis of ALD.