血清抗糖蛋白210抗体阳性的原发性胆汁性胆管炎患者临床特征分析  

Clinical feature of primary biliary cholangitis patients with serum anti glycoprotein 210 antibody positive

作　　者：姜正伟 周冰清[1] 汤洁 蒋蓓莉 Jiang Zhengwei;Zhou Bingqing;Tang Jie(Department of Gastroenterology,Fourth People's Hospital,Huai'an 223001,Jiangsu Province,China)

机构地区：[1]江苏省淮安市第四人民医院消化内科,223001 [2]南京医科大学附属淮安第一人民医院感染病科

出　　处：《实用肝脏病杂志》2024年第3期378-381,共4页Journal of Practical Hepatology

基　　金：江苏省高层次卫生人才“六个一”拔尖人才培养基金资助项目(编号:LGY2020059)。

摘　　要：目的总结血清抗糖蛋白210(抗gp210)抗体阳性的原发性胆汁性胆管炎(PBC)患者临床特征。方法2017年1月~2021年1月我院诊治的PBC患者63例,其中血清抗gp210抗体阳性患者21例(观察组),血清抗线粒体抗体(AMA)或AMA-M2阳性42例(对照组)。给予所有患者熊去氧胆酸(UDCA)13~15 mg·kg^(-1) d^(-1)治疗6个月。采用ELISA法检测血清白细胞介素-2(IL-2)、IL-6和IL-10水平,采用免疫比浊法检测血清IgA、IgG和IgM。结果观察组年龄和性别与对照组比差异均无统计学意义(P>0.05),但观察组乏力发生率为47.6%,显著高于对照组的35.7%(P<0.05);治疗前,观察组血清总胆红素(TBIL)、ALT和AST水平分别为30.1(18.5,66.1)μmol/L、73(42,110)U/L和87(64,126)U/L,均显著高于对照组【分别为20.1(10.4,31.5)μmol/L、53(27,90)U/L和68(53,101)U/L,P<0.05】,而血清白蛋白水平为32.2(29.8,35.2)g/L,显著低于对照组【34.6(30.4,36.8)g/L,P<0.05】;在治疗6个月后,观察组血清白蛋白水平为37.8(35.4,38.5)g/L,仍显著低于对照组【42.3(37.4,45.1)g/L,P<0.05】;治疗前,观察组血清IL-6和IL-10水平分别为12.7(5.8,11.3)pg/ml和125.1(87.4,120.6)pg/ml,均显著高于对照组【分别为9.1(7.0,11.7)pg/ml和103.6(90.1,117.0)pg/ml,P<0.05】;在治疗后,观察组血清IL-2和IL-6水平分别为29.1(18.4,36.5)pg/ml和7.2(5.2,8.5)pg/ml,均显著高于对照组【分别为21.0(9.7,26.3)pg/ml和5.4(4.0,6.9)pg/ml,P<0.05】,而血清IL-10水平为139.5(107.6,152.9)pg/ml,也显著低于对照组【154.8(122.7,168.2)pg/ml,P<0.05】;治疗后,观察组血清IgM、IgG和IgA水平分别为3.1(2.5,3.7)g/L、13.7(12.0,14.6)g/L和3.8(2.9,3.8)g/L,均显著高于对照组【分别为2.2(1.9,2.6)g/L、11.2(10.1,13.4)g/L和2.8(2.5,3.3)g/L,P<0.05】。结论血清抗gp210抗体阳性的PBC患者病情似乎更趋严重,对UDCA治疗应答稍差,值得临床扩大观察和研究。Objective The purpose of this study was to investigate the clinical feature of primary biliary cholangitis(PBC)patients with serum anti glycoprotein(gp)210 antibody positive.Methods 63 patients with PBC were encountered in our hospital between January 2017 and January 2021,and the diagnosis was made by serum anti mitochondrial antibody(AMA)/AMA-M2(control)or serum anti-gp 210(observation)positive.The ursodeoxycholic acid(UDCA)regimen was given to all the patients in the two groups.Serum cytokines and immunoglobulin levels were routinely assayed.Results There were no significant differences as respect to age and gender between the two groups(P>0.05),while the incidence of fatigue in the observation group was 47.6%,much higher than 35.7%(P<0.05)in the control;at admission,serum bilirubin,ALT and AST levels in the observation group were 30.1(18.5,66.1)μmol/L,73(42,110)U/L and 87(64,126)U/L,all significantly higher than[20.1(10.4,31.5)μmol/L,53(27,90)U/L and 68(53,101)U/L,P<0.05],while serum albumin(Alb)level was 32.2(29.8,35.2)g/L,significantly lower than[34.6(30.4,36.8)g/L,P<0.05]in the control;after six month treatment,serum Alb level in the observation was 37.8(35.4,38.5)g/L,still much lower than[42.3(37.4,45.1)g/L,P<0.05]in the control;before treatment,serum IL-6 and IL-10 levels in the observation were 12.7(5.8,11.3)pg/ml and 125.1(87.4,120.6)pg/ml,both significantly higher than[9.1(7.0,11.7)pg/ml and 103.6(90.1,117.0)pg/ml,P<0.05]in the control;at the end of six month treatment,serum IL-2 and IL-6 levels in the observation were 29.1(18.4,36.5)pg/ml and 7.2(5.2,8.5)pg/ml,both significantly higher than[21.0(9.7,26.3)pg/ml and 5.4(4.0,6.9)pg/ml,P<0.05]in the control,while serum IL-10 level was 139.5(107.6,152.9)pg/ml,much lower than[154.8(122.7,168.2)pg/ml,P<0.05]in the control;six months after treatment,serumIgM,IgG and IgA levels in the observation were 3.1(2.5,3.7)g/L,13.7(12.0,14.6)g/L and 3.8(2.9,3.8)g/L,all significantly higher than[2.2(1.9,2.6)g/L,11.2(10.1,13.4)g/L and 2.8(2.5,3.3)g/L,respectively,P<0.0

关 键 词：原发性胆汁性胆管炎 抗糖蛋白210抗体 熊去氧胆酸 临床特征 治疗 

分 类 号：R575.7[医药卫生—消化系统]