自身抗体及生化指标在原发性胆汁性肝硬化诊断中的应用  

Clinical application of auto-antibodies and biochemical indicators in the diagnosis of primary biliary cirrhosis

作　　者：张佳婕[1] 蔡强[2] 邓红艳[1] 李引钰[1] 薛富海 盛尚春 ZHANG Jiajie;CAI Qiang;DENG Hongyan;LI Yinyu;XUE Fuhai;SHENG Shangchun(Department of Clinical Laboratory,Affiliated Hospital of Chengdu University,Chengdu,Sichuan 610081,China;Department of Paediatrics,the No.2 People′sHospital of Yibin,Yibin,Sichuan 644000,China)

机构地区：[1]成都大学附属医院检验科,四川成都610081 [2]宜宾市第二人民医院儿科,四川宜宾644000

出　　处：《国际检验医学杂志》2019年第14期1686-1690,共5页International Journal of Laboratory Medicine

基　　金：国家自然科学基金委青年基金项目资助(81702101)

摘　　要：目的 探讨自身抗体联合生化指标在原发性胆汁性肝硬化诊断中的价值。方法 选取2017年 1- 12月在成都大学附属医院已确诊的原发性胆汁性肝硬化患者41例(PBC组),病毒性肝炎患者65例(病毒性肝炎组),体检健康者50例(健康对照组)作为研究对象。采用间接免疫荧光法检测抗核抗体(ANA)、抗线粒体抗体(AMA)、抗平滑肌抗体(ASMA)和抗肝肾微粒体抗体(LKM),免疫印迹法检测抗线粒体抗体M2(AMA-M2)、2-酮酸脱氢酶复合体(M2-3E,又名BPO)、肝肾微粒体抗体(LKM-1)、抗可溶性肝抗原/肝胰抗原抗体(SLA/LP)、抗肝细胞溶质抗原1型(LC-1)抗体。全自动生化分析仪测定丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、γ-谷氨酰基转移酶(GGT)、碱性磷酸酶(ALP)、总胆红素(TBil)和胆汁酸(TBA)等肝功生化指标并进行统计学分析。结果 PBC组ANA阳性率为97.50%,荧光核型分别为胞浆颗粒型 56.10 %、核颗粒型21.95%、着丝点型7.32%、核膜型7.32%和核点型4.88%。 PBC组ANA及AMA阳性率高于病毒性肝炎组和健康对照组,差异有统计学意义(χ 2 ANA =83.12、79.35,χ 2 AMA =58.61、54.58, P < 0.05 )。PBC组AMA-M2、M2-3E检出率分别与病毒性肝炎组、健康对照组比较差异有统计学意义(χ 2 AMA-M2 = 71.93 、 63.14 ,χ 2 M2-3E =78.77、69.36, P <0.05)。PBC组GGT、ALP水平显著高于病毒性肝炎组,差异有统计学意义( U GGT =492.50, U ALP =300.50, P <0.05)。结论 PBC患者可检测出AMA、AMA-M2、M2-3E等自身抗体,尤其是AMA-M2与M2-3E联合检测并且生化肝功指标升高,有助于疾病早期诊断。Objective To investigate the value and clinical significance of auto-antibodies and biochemical indicators in primary biliary cirrhosis(PBC). Methods 41 patients with primary biliary cirrhosis diagnosed in the affiliated hospital of chengdu university from January to December 2017 (PBC group),65 patients with viral hepatitis (viral hepatitis group) and 50 healthy people (healthy control group) were selected as research objects.Antinuclear antibody (ANA),anti-mitochondrial antibody (AMA),anti-smooth muscle antibody (ASMA) and anti-liver-kidney microsomal antibody (LKM) were detected by indirect immunofluorescence.Western Blot method was used to detect anti-mitochondrial antibody(AMA-M2),2-keto acid dehydrogenase complex(M2-3E,also known as BPO),anti-liver-kidney microsomal antibody-1 (LKM-1),anti-soluble liver antigen/liver-pancreas(SLA/LP),anti-liver cytosol antibody type 1 (LC-1).Alanine aminotransferase (ALT),aspartate aminotransferase (AST),gamma-glutamyl transferase (GGT),alkaline phosphatase (ALP),total bilirubin (TBil),bile acid (TBA) and other biochemical indexes of liver function were determined by automatic biochemical analyzer and analyzed statistically. Results The positive rate of ANA in PBC group was 97.50%,the fluorescence patterns were cytoplasmic particle type 56.10%,nuclear particle type 21.95%,centromere type 7.32%,nuclear membrane type 7.32% and nuclear dot type 4.88%.The positive rate of ANA and AMA in PBC group were higher than that in viral hepatitis group,the difference was statistically significant (χ 2 ANA =83.12,79.35,χ 2 AMA = 58.61,54.58, P <0.05).The detection rates of AMA-M2 and M2-3E in PBC group were significantly different from those in viral hepatitis group and the healthy control group (χ 2 AMA-M2 =71.93, 63.14 ,χ 2 M2-3E = 78.77 , 69.36 , P <0.05).The levels of GGT and ALP in PBC group were significantly higher than those in viral hepatitis group,and the difference was statistically significant ( U GGT =492.50, U ALP = 300.50 , P <0.05). Conclusion Auto-antibodies such as A

关 键 词：原发性胆汁性肝硬化 自身抗体 生化指标 

分 类 号：R575.22[医药卫生—消化系统]