乙型病毒性肝炎与原发性胆汁性胆管炎患者血清抗线粒体抗体M2亚型表达的特征分析  

Study on the Serological Characteristics of Anti-Mitochondria M2 Subtype in Patients with Hepatitis B and Primary Biliary Cholangitis

作　　者：赵敏 李勤光 卓传尚 ZHAO Min;LI Qin-guang;ZHUO Chuan-shang(Department of Clinical Laboratory,Mengchao Hepatobiliary Hospital of Fujian Medical University,Fuzhou 350025,China)

机构地区：[1]福建医科大学孟超肝胆医院检验科,福州350025

出　　处：《现代检验医学杂志》2020年第6期16-20,共5页Journal of Modern Laboratory Medicine

摘　　要：目的对比分析抗线粒体抗体M2亚型(anti-mitochondrial antibody M2 subtype,AMA-M2)阳性的乙型病毒性肝炎患者和原发性胆汁性胆管炎(primary biliary cholangitis,PBC)患者的特征,为临床上M2阳性病毒性乙型肝炎和PBC的鉴别诊断提供参考。方法回顾性分析2015年1月~2018年6月期间在福建医科大学孟超肝胆医院就诊的174例AMA-M2阳性肝功能异常患者的临床资料,将其中37例M2阳性乙型病毒性肝炎组的性别、年龄、肝功能、血脂水平、免疫学指标和自身抗体检测等与同期129例原发性胆汁性胆管炎组和8例乙型病毒性肝炎并发PBC组进行对比分析。结果AMA-M2阳性乙肝组、PBC组和乙肝并发PBC组三组间性别构成差异有统计学意义(χ2=25.23,P<0.05)。乙肝组抗核抗体(ANA)阳性率(67.57%)低于PBC组(98.45%)和乙肝并发PBC组(100%),且以低滴度为主,而PBC组和乙肝并发PBC组以高滴度为主(U=22.0,367.0,均P<0.05)。PBC组和乙肝并发PBC组AMA阳性率分别为93.02%和100%,均高于乙肝组(21.62%),且以高滴度为主,而乙肝组主要以低滴度为主(U=6.50,283.5,均P<0.05)。乙肝组与PBC组相比ALT,GGT,ALP,IgM,TC,HLD和LDL水平差异均有统计学意义(U=717~1678,均P<0.05),乙肝组与乙肝并发PBC组相比仅GGT和IgM水平差异具有统计学意义(U=40.5~44.5,均P<0.05),而PBC组和乙肝并发PBC组之间差异无统计学意义(P>0.05)。结论AMA-M2抗体并非仅见于PBC,也可在乙型病毒性肝炎等非PBC患者中检出,单纯M2阳性乙肝病人抗核抗体和AMA抗体多以低滴度为主且M2抗体多为弱阳性,而乙型肝炎并发PBC者常与之相反;其次,单纯M2阳性乙肝病人ALT升高较为明显,若血清GGT,ALP和IgM水平升高较为明显且血脂异常者则并发PBC的可能性比较大。Objective To compare and analyze the characteristics of hepatitis B patients with positive anti mitochondrial antibody M2 subtype(AMA-M2)and primary biliary cholangitis(PBC),so as to provide reference for the differential diagnosis of M2 positive viral hepatitis B and PBC.Methods The clinical data of 37 patients with AMA-M2 positive hepatitis B in Mengchao Hepatobiliary Hospital of Fujian Medical University from January 2015 to June 2018 were analyzed retrospectively.The sex,age,liver function,blood lipid level,immunological index and autoantibody of M2 positive hepatitis B group were compared with 129 cases of primary cholangitis and 8 cases of hepatitis B complicated with PBC in the same period.Results There were significant differences in gender composition among AMA-M2 positive hepatitis B group,PBC group and hepatitis B combined with PBC group(χ2=25.23,P<0.05).The positive rate of anti-nuclear antibody in hepatitis B group(67.57%)was lower than that in PBC group(98.45%)and hepatitis B combined with PBC(100%)and mainly low titer,while that in PBC group and hepatitis B combined with PBC group was mainly high titer(U=22.0,367.0,all P<0.05).The positive rates of AMA in PBC group and HBV combined with PBC group were 93.02%and 100%,respectively,higher than that in HBV group(21.62%)and were mainly high titer,while that in HBV group was mainly low titer(U=6.50,283.5,all P<0.05).The levels of ALT,GGT,ALP,IgM,TC,HLD and LDL in hepatitis B group were significantly different from those in PBC group(U=717~1678,all P<0.05),while the levels of GGT and IgM in hepatitis B group were significantly different from those in hepatitis B combined with PBC group(U=40.5~44.5,all P<0.05),while there was no statistical difference between PBC group and hepatitis B combined with PBC group(P>0.05).Conclusion AMA-M2 antibody is not only found in PBC,but also can be detected in non-PBC patients such as viral hepatitis B.The anti nuclear antibody and AMA antibody of simple M2 positive hepatitis B patients are mainly low titer,and M2 antibo

关 键 词：乙型病毒性肝炎 抗线粒体抗体M2亚型 原发性胆汁性胆管炎 

分 类 号：R512.62[医药卫生—内科学] R575.7[医药卫生—临床医学]