自身抗体检测在原发性胆汁性肝硬化诊断中的价值  

Diagnostic significance of autoantibodies in patients with primary biliary cirrhosis

作　　者：肖华[1,2] 陈进伟[1] 谢希[1] 刘一鸣[1] 李芬[1] 

机构地区：[1]中南大学湘雅二医院风湿免疫科,长沙410011 [2]郴州市第一人民医院风湿免疫科,郴州423000

出　　处：《北京大学学报（医学版）》2012年第2期209-214,共6页Journal of Peking University:Health Sciences

摘　　要：目的:探讨检测多种自身抗体在原发性胆汁性肝硬化(primary biliary cirrhosis,PBC)诊断中的价值。方法:回顾性分析中南大学湘雅二医院风湿免疫科330例拟诊或需除外PBC的患者(最后确诊34例PBC,296例非PBC)病例资料,采用欧蒙免疫印记法半定量检测血清中的抗线粒体抗体M2亚型抗体(anti-mitochondrial antibo-dies-M2,AMA-M2)、抗三联体抗体(anti-BCOADC-E2 PDC-E2 OGDC-E2 antibodies,anti-3E/BPO)、抗可溶性酸性磷酸化核蛋白SP100抗体(anti-SP 100 antibodies,anti-SP100)、抗早幼粒细胞白血病抗体(anti-promyelocytic leukemia,anti-PML)、抗核包膜蛋白gp210抗体(anti-gp210 antibodies,anti-gp210)及抗Ro-52,并对以上抗体进行诊断价值评估及临床意义探讨。结果:(1)34例确诊PBC患者AMA-M2、抗3E/BPO、抗SP100、抗PML、抗gp210和抗Ro-52抗体灵敏度(sensitivity,Sen)/特异度(specificity,Spe)分别为85.3%/84.8%、79.4%/93.2%、35.3%/98.0%、41.2%/96.3%、44.1%/96.6%和61.8%/68.6%;AMA-M2分别与抗3E/BPO、抗SP100、抗PML、抗gp210和抗Ro-52抗体串联检测(series test)特异度分别为94.9%、99.3%、99.3%、98.3%和92.2%,并联检测(parallel test)灵敏度分别为91.2%、94.1%、94.1%、94.1%和91.2%;(2)PBC患者中AMA-M2阳性组和阴性组、抗3E/BPO阳性组和阴性组、抗SP100阳性组和阴性组、抗PML阳性组和阴性组、抗gp210阳性组和阴性组、抗Ro-52阳性组和阴性组的各项生化指标、临床症状相比,差异均无统计学意义(P﹥0.05);(3)AMA-M2阳性的PBC患者中41.3%(12/29)抗gp210阳性,31.3%(9/29)抗SP100抗体阳性,37.9%(11/29)抗PML抗体阳性;而AMA-M2阴性的PBC患者中60%(3/5)出现抗gp210,抗SP100,抗PML抗体阳性,两组间差异具有统计学意义(P=0.003、P=0.00、P=0.00)。结论:(1)AMA-M2和抗3E(BPO)诊断PBC的敏感度高于抗SP100、抗PML和抗gp210抗体,可作为诊断PBC的筛选试验抗体;(2)抗gp210、抗SP100和抗PML抗体诊断PBC的特异度高于AMA-M2,有助于AMA-M2阴性的PBC患者的确诊;(3)AMObjective： To investigate the significance of autoantibodies in patients with primary biliary cirrhosis（PBC）.Methods： A anti-mitochondrial antibodies-M2（AMA-M2）,anti-BCOADC-E2 PDC-E2 OGDC-E2 antibodies（anti-3E/BPO）,anti-SP100 antibodies（anti-SP100）,anti-promyelocytic leukemia（anti-PML）,anti-gp210 antibodies（anti-gp210）,and anti-Ro-52 were detected respectively in 330 suspected PBC cases by Western blotting.Results：（1） The sensitivity/specificity rates of AMA-M2,anti-3E/BPO,anti-SP100,anti-PML,anti-gp210,and anti-Ro-52 were 85.3%/84.8%,79.4%/93.2 %,35.3%/98.0%,41.2%/96.3%,44.1%/96.6%,61.8%/68.6% respectively;AMA-M2 were combined with the other antibodies.The specificity rates in the series tests were 94.9%,99.3%,99.3 %,98.3%,and 92.2%,while the sensitivity rates in the parallel tests were 91.2%,94.1%,94.1%,94.1%,and 1.2%,respectively.（2）There were 5 cases of AMA-M2 negative in patients with PBC,including 60%（3/5） cases of anti-gp210,anti-SP100 and anti-PML positive respectively.Conclusion：（1） AMA-M2 were more sensitive than other antibodies,while the specificity rates of anti-3E/BPO,anti-SP100,anti-PML,and anti-gp210 were higher than that of AMA-M2;Parallel tests helps to exclude the suspected PBC cases and series tests could be useful in clinics to confirm the PBC cases.（2） Anti-gp210,anti-SP100,anti-PML antibodies appear to be more common in AMA-M2 negative PBC patients than in those who are AMA-M2 positive,and their presence in AMA-M2 negative PBC patients contributes to the PBC diagnosis.

关 键 词：肝硬化 胆汁性 自身抗体 诊断 

分 类 号：R446.622[医药卫生—诊断学]