自身抗体检测在自身免疫性肝病患者中的临床应用价值分析  

To analyze the clinical application value of autoantibodies detection in patients with autoimmune liver disease

作　　者：李娅 李艳[2] 段勇[2] 熊秋霞[2] LI Ya;LI Yan;DUAN Yong;XIONG Qiuxia(Department of Clinical Laboratory,Kunming Jinning District People′s Hospital,Kunming,Yunnan 650600,China;Yunnan Province Clinical Research Center for Laboratory Medicine/Yunnan Key Laboratory of Laboratory Medicine/Department of Clinical Laboratory,the First Affiliated Hospital of Kunming Medical University,Kunming,Yunnan 650032,China)

机构地区：[1]昆明市晋宁区人民医院检验科,云南昆明650600 [2]云南省检验医学临床研究中心/云南省检验医学重点实验室/昆明医科大学第一附属医院医学检验科,云南昆明650032

出　　处：《检验医学与临床》2023年第S02期1-6,共6页Laboratory Medicine and Clinic

基　　金：国家自然科学基金项目(82060515);云南省科技厅技术创新人才项目(202105AD160005)。

摘　　要：目的研究各型自身免疫性肝病(AILD)患者的自身抗体特点和荧光模型特点,以便对AILD进行诊断和鉴别诊断。方法回顾性分析昆明医科大学第一附属医院2019年10月—2022年10月确诊的253例AILD患者,比较原发性胆汁性胆管炎(PBC)158例、自身免疫性肝炎(AIH)64例、PBC合并AIH的重叠综合征(OS)患者31例的AILD抗体谱、抗核抗体谱(ANAs)及荧光模型特点。结果(1)AILD以女性高发,发病年龄多以中老年为主(50~60岁);(2)在AILD抗体谱检测中,PBC组患者的抗线粒体抗体M2亚型(AMA-M2)和2-丙酮酸脱氢酶(M2-3E)抗体阳性率高于AIH组和OS组,且与AIH组相比,差异有统计学意义(P<0.05)。(3)OS组未检出抗可溶性肝抗原/肝胰抗原抗体(SLP/LP),AIH组SLP/LP的阳性率高于PBC组,差异有统计学意义(P<0.05);(4)三组检出率最高的荧光模型均为线粒体型,PBC组线粒体型的检出率高于AIH组和OS组,与AIH组相比,差异有统计学意义(P<0.05)。(5)平滑肌抗体(ASMA)和肌动蛋白型仅出现在AIH组和OS组患者中;(6)抗核抗体谱(ANAs)中的抗SSA抗体(AIH组31.6%、OS组10%、PBC组35%)、抗SSB抗体(AIH组4%、OS组1%、PBC组12%)和抗RNP抗体(AIH组4%、OS组1%、PBC组15%)虽在三组患者中阳性率均最高,差异无统计学意义(P>0.05)。结论AILD特异性抗体和ANAs的靶抗原,在各型AILD中都有不同的阳性率,各组的荧光模型均具有特征性表现,提示在临床应用时,应结合三者进行综合分析,以便对疾病进行诊断和鉴别诊断。Objective To study the characteristics of autoantibody and fluorescent model in patients with various types of autoimmune liver disease,so as to make diagnosis and differential diagnosis of autoimmune liver disease.Methods A total of 253 patients with autoimmune liver disease diagnosed in the First Affiliated Hospital of Kunming Medical University from October 2019 to October 2022 were retrospectively analyzed.Primary biliary cholangitis(PBC,n=158),autoimmune hepatitis(AIH,n=64),and the overlap syndrome of PBC and AIH(OS,n=64)were compared.31 cases of autoimmune liver disease antibody spectrum,antinuclear antibody spectrum(ANAs)and fluorescence model characteristics.Results(1)Autoimmune liver disease was more common in women,and the onset age was mainly in the elderly(51 to 60 years old).(2)Autoimmune liver disease antibody profile:the positive rate of anti-mitochondrial antibody M2 subtype(AMA-M2)and 2-pyruvate dehydrogenase(M2-3E)antibody in PBC group was higher than that in AIH group and OS group,and the difference was statistically significant compared with AIH(P<0.05).(3)There was no anti-soluble liver antigen/liver pancreatic antigen antibody(SLP/LP)detected in OS group,and the positive rate of SLP/LP in AIH group was higher than that in PBC group and OS group,and the difference was statistically significant(P<0.05).(4)The highest detection rate of mitochondrial model in the three groups was all mitochondrial model.The detection rate of mitochondrial model in PBC group was higher than that in AIH group and OS group,and the difference was statistically significant compared with AIH group.(5)Smooth muscle antibody(ASMA)and actin were only detected in AIH and OS groups,but not in PBC group.(6)Although the positive rates of anti-SSA antibody(AIH group 31.6%,OS group 10%,PBC group 35%),anti-SSB antibody(AIH group 4%,OS group 1%,PBC group 12%)and anti-RNP antibody(AIH group 4%,OS group 1%,PBC group 15%)in the antinuclear antibody spectrum(ANAs)were the highest in the three groups,the differences were not statisti

关 键 词：自身抗体 荧光模型 原发性胆汁性胆管炎 自身免疫性肝炎 重叠综合征 

分 类 号：R575[医药卫生—消化系统]