原发性胆汁性肝硬化患者自身抗体测定的意义  

Clinical application of autoantibodies in patients with primary biliary liver cirrhosis

作　　者：刘宁[1] 谭立明[1] 董叶[2] 曹莉萍[1] 李华[1] 蔡莉莉[1] 徐承云[3] 

机构地区：[1]南昌大学第二附属医院检验科,江西省南昌市330006 [2]南昌大学第二附属医院消化内科,江西省南昌市330006 [3]南昌大学第二附属医院肾内科,江西省南昌市330006

出　　处：《世界华人消化杂志》2007年第21期2358-2361,共4页World Chinese Journal of Digestology

摘　　要：目的:探讨自身抗体测定对诊断原发性胆汁性肝硬化(PBC)的临床意义.方法:PBC患者52例和非PBC患者202例,其中包括自身免疫性肝炎(AIH)41例,原发性硬化型胆管炎(PSC)18例,乙型肝炎(HBV)89例,丙型肝炎(HCV)54例以及健康体检者40例,采用间接免疫荧光法(IIF)检测抗核抗体(ANA)、抗平滑肌抗体(SMA)、抗线粒体抗体(AMA)、抗心肌抗体(HRA)、抗骨骼肌抗体(ASA)、抗胃壁细胞抗体(PCA)、抗双链DNA(ds-DNA)抗体、抗肝肾微粒体抗体(LKM)、抗可溶性肝抗原(SLA)抗体和抗中性粒细胞胞质抗体(ANCA)等自身抗体,ELISA法检测抗髓过氧化酶抗体(MPO),并对其结果进行回顾性分析.结果:PBC患者中AMA阳性例数最高为46例(88.5%),ANA阳性率为71.2%(37/52);非PBC患者中阳性例数则分别为20例(9.9%)和51例(25.2%),两组比较,有非常显著性意义(P<0.01).AMA、SMA抗体检测在PBC与AIH患者中,均有非常显著性意义(P<0.01).但两组之间的ANA阳性率无显著性意义(P>0.05).PSC患者18例ANA阳性6例,AMA阳性7例均低于PBC患者.HBV,HCV感染患者检测ANA阳性率分别只有9.0%和22.2%;AMA阳性率也只有7.9%和3.7%,与PBC患者比较均有显著性差异(P<0.01).PBC患者及对照组检测ds-DNA,ANCA,LKM,SLA和MPO抗体结果显示PBC患者检测最高的ANCA阳性率为26.9%(14/52),其次是MPO阳性率为25.0%(13/52),与AIH比较,均有非常显著性意义(P<0.01).结论:血清自身抗体的检测对诊断、治疗和阻止原发性胆汁性肝硬化的发展有着十分重要作用.对提高PBC同其他疾病鉴别诊断和治疗有着非常重要的意义.AIM： To study the clinical significance of autoantibodies in patients with primary biliary liver cirrhosis （PBC）. METHODS： The patients with PBC （n = 52）, non-PBC （n = 202） and healthy physical examination people （n = 40） were examined in this research. Autoantibodies against cell nuclei （ANA）, smooth muscle （SMA）, mitochondria （AMA）, heart cells, skeletal muscle, parietal cells, double-stranded DNA, live-kidney microsomes, soluble antigen, and neutrophil cytoplasm were detected by indirect immunofluorescence assay, and anti-myeloperoxidase （MPO） autoantibodies were detected by enzyme-linked immunosorbent assay. RESULTS： AMA positive rate was 88.5% （46/52）,which was the highest positive rate in PBC patients. ANA positive rate was 71.2% （37/52） in PBC patients. In non-PBC patients, 20 （positive rate 9.9%） were positive for AMA and 51 （25.2%） were positive for ANA, and these levels were much lower than those in patients with PBC （P 〈 0.01）. AMA and SMA in patients with PBC and autoimmune hepatitis （AIH） were markedly different from each other （P 〈 0.01）. However, ANA did not differ between PBC and AIH patients. Among 18 patients with primary sclerosing cholangitis （PSC）, six were positive for ANA, seven for AMA, and these rates were lower than those in PBC. The ANA positive rate in hepatitis B and hepatitis C patients was 9.0 and 22.2%, respectively. AMA positive rate in hepatitis B and hepatitis C patients was 7.9 and 3.7%, respectively. These data were significantly different from those in PBC patients （P 〈 0.01）. ANCA positive rate was 26.9% （14/52） in PBC patients, followed by MPO （25.0%）. After ;（2 test, both were much higher than those in AIH patients （P 〈 0.01）. CONCLUSION： Determination of serum autoantibodies is important for the diagnosis and treatment of PBC, and is valuable for distinguishing PBC from other diseases.

关 键 词：原发性胆汁性肝硬化 抗线粒体抗体 抗核抗体 抗中性粒细胞胞质抗体 抗髓过氧化酶抗体 间接免疫荧光法 酶联免疫测定 

分 类 号：R575.2[医药卫生—消化系统]