抗线粒体抗体与原发性胆汁性胆管炎临床血清学和肝硬化指标的相关性  

Correlation between anti-mitochondrial antibodies and clinical serological and cirrhotic markers of primary biliary cholangitis

作　　者：靳睿 王晓晓[1] 王力华[2] 马慧[1] 房继莲[1] 王豪[1] 饶慧瑛[1] 魏来[1] 封波[1] Jin Rui;Wang Xiaoxiao;Wang Lihua;Ma Hui;Fang Jilian;Wang Hao;Rao Huiying;Wei Lai;Feng Bo(Peking University People′s Hospital,Hepatology Institute of Peking University,Beijing Key Laboratory of Hepatitis C and Immunotherapy for Liver Diseases,Beijing 100044,China;Information Center of Peking University People′s Hospital,Beijing 100044,China)

机构地区：[1]北京大学人民医院,北京大学肝病研究所,丙型肝炎和肝病免疫治疗北京重点实验室,100044 [2]北京大学人民医院医学信息中心,100044

出　　处：《中华消化杂志》2020年第1期16-22,共7页Chinese Journal of Digestion

摘　　要：目的探究首次就诊的抗线粒体抗体(AMA)阳性原发性胆汁性胆管炎(PBC)患者的AMA水平及其与临床指标的相关性。方法通过北京大学人民医院信息系统,收集2013年1月至2016年12月首次检测AMA和(或)M2型抗线粒体抗体(AMA-M2)阳性的1323例患者的临床资料,其中采用间接免疫荧光法183例、免疫印迹法431例、ELISA法709例;分为未诊断PBC组(973例)和新诊断PBC组(350例,其中非肝硬化者268例,肝硬化者82例)。709例采用ELISA法的患者中,未诊断PBC组567例,新诊断PBC组142例(PBC非肝硬化组115例,PBC肝硬化组27例)。183例采用间接免疫荧光法的患者中,未诊断PBC组118例,新诊断PBC组65例;其中AMA滴度为低滴度(1∶40~1∶80)者69例(未诊断PBC组53例,新诊断PBC组16例)、中滴度(1∶160~1∶320)者95例(未诊断PBC组59例,新诊断PBC组36例)、高滴度(≥1∶640)者19例(未诊断PBC组6例,新诊断PBC组13例)。比较各组患者的AMA水平,分析其与PBC临床指标免疫球蛋白(Ig)G、IgM、血小板计数、ALT、AST、GGT、ALP、血清总蛋白、TBil、总胆固醇,以及肝硬化指标天冬氨酸转氨酶与血小板比率指数(APRI)、基于四因子的纤维化指数(Fib-4)的相关性。统计学方法采用Mann-Whitney U检验、Kruskal-Wallis检验和线性回归分析。结果采用ELISA法检测的709例患者的AMA-M2滴度中位值为53 RU/mL,新诊断PBC组的血清AMA和AMA-M2中位水平均高于未诊断PBC组(1∶320比1∶80和180 RU/mL比47 RU/mL),差异均有统计学意义(χ^2=14.111,Z=-7.531,P均<0.01)。未诊断PBC组的AMA-M2值与年龄、IgG、IgM、AST、GGT、ALP、血清总蛋白、总胆固醇水平均呈正相关,均有统计学意义(Rho值=0.114、0.108、0.337、0.089、0.197、0.086、0.121、0.073,P均<0.05);新诊断PBC组的AMA-M2值与年龄、IgM、血清总蛋白、总胆固醇水平均呈正相关,与血小板计数呈负相关,均有统计学意义(Rho值=0.218、0.483、0.230、0.161、-0.183,P均<0.05);PBC非肝硬化Objective To explore the correlation between the level of anti-mitochondrial antibody(AMA)and clinical indicators of first visited primary biliary cholangitis(PBC)patients with positive AMA.Methods From January 2013 to December 2016,the clinical data of 1323 patients with positive AMA and/or AMA-M2 detected for the first time were collected through the Information System of Peking University People′s Hospital.Among them,183 were detected by indirect immunofluorescence assay,431 were measured by immunoblotting,and 709 were determined by enzyme-linked immunosorbent assay(ELISA).Patients were divided into undiagnosed PBC group(non-PBC group,973 cases)and newly diagnosed PBC group(new-PBC group,350 cases including 268 cases of non-liver cirrhosis and 82 cases of liver cirrhosis);among 709 cases detected by ELISA,there were 567 cases in the non-PBC group and 142 cases in the new-PBC group(115 cases of non-liver cirrhosis PBC group and 27 cases of liver cirrhosis PBC group).Among 183 cases determined by indirect immunofluorescence assay,there were 118 cases in the non-PBC group and 65 cases in the new-PBC group.Among them 69 cases with low AMA titer(1∶40—1∶80)(53 cases of non-PBC group and 16 cases of new-PBC group),95 cases with medium titer(1∶160—1∶320)(59 cases of non-PBC group and 36 cases of new-PBC group)and 19 cases with high titer(≥1∶640)(six cases of non-PBC group and 13 cases of new-PBC group).AMA levels among groups were compared,and its correlation with clinical serology and cirrhosis indicators of PBC including immunoglobulin(Ig)G,IgM,platelet,alanine aminotransferase(ALT),aspartate aminotransferase(AST),γ-glutamyltranspeptadase(GGT),alkaline phosphatase(ALP),serum total protein,serum albumin,total bilirubin(TBil),total cholesterol(TC),and aspartate aminotransferase to platelet ratio index(APRI)and fibrosis(Fib-4)was analysed.Mann-Whitney U test,Kruskal-Wallis test,and linear regression analysis were performed for statistical analysis.Results By ELISA method,the median titer of AMA-M2 of

关 键 词：抗线粒体抗体 原发性胆汁性胆管炎 肝硬化 临床意义 

分 类 号：R575[医药卫生—消化系统]