血清特异抗体阴性的原发性胆汁性胆管炎的临床研究  

Clinical characteristics of primary biliary cirrhosis with negative serum specific antibodies

作　　者：李卫昆 李惠敏 常丽仙 彭丹 刘春云 祁燕伟 牟春燕 张映媛 许丹青 刘立 LI Wei-kun;LI Hui-ming;CHANG Li-xian;PENG Dan;LIU Chun-yun;QI Yan-shan;MOU Chun-yan;ZHANG Yin-yuan;XU Dan-qing;LIU Li(Department of liver disease,The third people’s hospital of Kunming city,Yunnan,650041,China)

机构地区：[1]昆明市第三人民医院肝病三科,650041

出　　处：《肝脏》2022年第7期795-799,共5页Chinese Hepatology

基　　金：云南省昆明市科技局科技保障民生发展计划资助项目(昆科计字2019-1-S-25318000001245)。

摘　　要：目的比较血清抗线粒体抗体(AMA)阴性与阳性的原发性胆汁性胆管炎(primary biliary cirrhosis,PBC)患者的临床特征与病理表现。方法选择2017年1月至2020年12月因肝功能异常半年及以上,同时伴有GGT、ALP升高患者,根据纳入与排除标准获得最终研究对象。对所有入选病例行肝脏穿刺病理学检查,将研究对象分为AMA阴性与AMA阳性组。比较两组患者血常规、血清生化、甲状腺功能以及病理学指标。统计学处理使用t检验和卡方检验。结果PBC患者中女性居多,且主要集中于50~55岁。AMA阴性PLT水平为(183.27±1.67)与AMA阳性为(265.67±1.37)患者比较差异有统计学意义(P<0.05),其他指标均差异无统计学意义。肝功能结果显示,AMA阴性组患者GGT为(444.5±2.72),高于AMA阳性组(276.33±3.86)。AMA阴性组TG为(1.74±0.58)、LDL-C为(3.57±0.42)升高程度低于AMA阳性组TG(1.97±0.94)、LDL-C(4.87±0.7)含量,而免疫球蛋白IgE的表达则相反,AMA阴性组IgE的表达(70.15±0.91),AMA阳性组IgE的表达(33.67±0.65)(P=0.023、0.016、0.011)。甲状腺功能分析结果显示,AMA阴性组T4表达水平(110.72±10.34)nmol/L低于阳性组(122.56±10.88)nmol/L(P<0.05)。两组患者自身免疫抗体阳性结果显示,LKM1在PBC中不表达,而AMA阴性组ANA(86.36%)及RO52(81.82%)表达高于AMA阳性组ANA(9.26%)及RO52(14.81%)(P<0.05)。细胞角蛋白CK7、CK19免疫组化结果显示,两组患者阳性率无统计学差异。结论AMA阴性与阳性PBC患者的临床特征以及病理表现具有很高的相似性,应对AMA阴性患者给予同等重视,肝组织病理学检查为必要措施。Objective Comparing a series of clinical features and pathological manifestations of patients with primary biliary cirrhosis(PBC)with negative and positive anti-mitochondrial antibodies(AMA),in order to provide a theoretical basis for the diagnosis and treatment of AMA-negative PBC patients.Methods From January 2017 to December 2020,patients with abnormal liver function for half a year or more,accompanied by elevatedγ-glutamyl transpeptidase(GGT)and alkaline phosphatase(ALP)were selected,and the final subjects were obtained according to the inclusion and exclusion criteria.Liver puncture pathological examination was performed on all selected subjects,and they were divided into AMA negative and positive groups.Routine blood,serum biochemical,thyroid function and pathological tests were performed on the two groups.After collecting the clinical data,SPSS25.0 was used for data analysis.The counting data were expressed as(mean±standard deviation),and t test was used for comparison between the two groups.The measurement data was expressed by rate or percentage(%),and chi-square test was used for the comparison of rates between two groups.Results The results showed that the majority of PBC patients with AMA negative(19 cases)and positive(49 cases)were female,and the patients were mainly 50-55 years old.There was no difference in age and sex between the two groups(P<0.05).Laboratory test results showed that there was statistically significant difference between AMA negative(183.27±1.67)and AMA positive(265.67±1.37)in PLT levels of blood routine(P<0.05),and no difference in other indicators.In addition,liver function test results showed that the GGT value of patients in the AMA negative group(444.5±2.72)was higher than that in the AMA positive group(276.33±3.86).For biochemical factors,the results showed that the levels of triglyceride(TG)and low-density lipoprotein cholesterol(LDL-C)in AMA negative group were lower than those in AMA positive group[TG:(1.74±0.58)vs(1.97±0.94),P=0.023;LDL-C:(3.57±0.42)vs(4.87±0.7

关 键 词：AMA AMA-M2 阴性 原发性胆汁性肝硬化 临床特征 

分 类 号：R575.7[医药卫生—消化系统]