多种自身抗体联合检测对自身免疫性肝病的诊断价值
| 作者: |
1任妹,
1廖永强,
1彭可君,
1孟芳,
1俞丹菁
1 萍乡市人民医院检验科， 江西 萍乡 337055 |
| 通讯: |
任妹
Email: 47478175@qq.com |
| DOI: | 10.3978/j.issn.2095-6959.2014.04.013 |
摘要
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 di seases，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 ant ibodi es，ANA)、抗平滑肌抗体(ant i - smooth musc l e ant ibodi es， 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。
关键词：
自身免疫性肝病；病毒性肝炎；抗肝抗原抗体；抗核抗体
Diagnosis value of multiple autoimmune antibody detection in autoimmune liver diseases
CorrespondingAuthor: REN Mei Email: 47478175@qq.com
DOI: 10.3978/j.issn.2095-6959.2014.04.013
Abstract
Objective: To explore the detection rate of various autoantibodies and its diagnosis value in patients with autoimmune liver diseases (ALD). Methods: According the clinical diagnose, the patients were divided into a ALD group (ALD group, n=96), a virus hepatitis group (n=135, 75 cases of HBV, 60 cases of HCV), while 62 cases healthy people served as a healthy control group (n=62). The ALD group was also divided into a autoimmune hepatitis group (AIH group, n=36), a primary biliary cirrhosis group (PBC group, n=58), and a primary sclerotic cholangitis group (PSC group, n=2). Indirect immunefluorescence assay was used to detect the expression of antinuclear antibodies (ANA), smooth muscle antibodies (ASMA), antimitochondrial ant-ibodies (AMA); Western blotting was used to detect the anti liver-kidney microsomal antibody Type 1 (LKM-1), subtype of AMA (AMA-M2), soluble liver antigen/liver pancreas (SLA/LP) and antihepatocyte cytosol antigen Type 1 (LC-1). Results: The positive rates of ANA in the AIH group (69.4%) and the PBC group (87.9%) were higher than that in the virus hepatitis group (37.3%) and the healthy control group (4.8%) (all P<0.01); the positive rates of the ASMA (44.4%), LKM-1 (11.1%), SLA/LP (2.8%), LC-1 (8.3%) in the AIH group were higher than those in the virus hepatitis group (1.3%, 1.7%, 0, 0) and the healthy control group (all P<0.01); the positive rates of AMA-M2 (91.3%) in the PBC group was higher than that in the virus hepatitis group (1.3%) and the healthy control group (0) (both P<0.01). Conclusion: The united detection of ANA, ASMA, SLA/LP, LC-1, LKM-1 and AMA-M2 in obscure liver injury patients is important for improving the sensitivity and specificity of ALD diagnosis, and also is useful for classification and treatment in ALD.