自身免疫抗体谱及抗核抗体核型检测在自身免疫性肝病中的诊断价值

Diagnostic value of autoimmune antibody spectrum and antinuclear antibody karyotype in autoimmune liver disease

目的探讨自身免疫抗体谱及抗核抗体(ANA)核型在原发性胆汁性胆管炎(PBC)、自身免疫性肝炎(AIH)和重叠综合征(PBC-AIH)中的诊断价值。方法收集福建医科大学孟超肝胆医院2019年1月-2021年12月住院的130例PBC患者、82例AIH和84例重叠综合征患者资料,采用间接免疫荧光法检测ANA核型、抗线粒体抗体(AMA)、抗平滑肌抗体(ASMA),采用免疫印迹法检测抗线粒体抗体M2型(AMA-M2)、抗肝肾微粒体抗体Ⅰ型(LKM-1)、抗肝细胞质Ⅰ型抗体(LC-1)、抗可溶性肝抗原抗体(SLA)、抗核膜糖蛋白210(gp210)、抗可溶性酸性磷酸化核蛋白(sp100)。结果PBC组ANA核型主要为胞浆颗粒型、核膜型、线粒体型、着丝点型,这些核型阳性率显著高于AIH组,但仅核膜型阳性率高于重叠综合征组(χ^(2)=8.61),差异均有统计学意义(P均<0.05);AIH组ANA核型主要为颗粒型、均质型、核仁型,其阳性率均显著高于PBC组,差异有统计学意义(P均<0.05);重叠综合征组ANA核型主要为胞浆颗粒型、线粒体型、核点型、核膜型,均高于AIH组,差异有统计学意义(P均<0.05)。自身免疫抗体谱检出阳性率方面,PBC组AMA、AMA-M2、gp210、sp100阳性检出率显著高于AIH组,ASMA、SLA阳性检出率低于AIH组,AMA阳性检出率高于重叠综合征组(χ^(2)=14.21),差异均有统计学意义(P均<0.05)。结论ANA核型联合自身免疫抗体谱检测分析有助于提高自身免疫性肝病分型诊断。

Objective To investigate the diagnostic value of spectrum of autoimmune antibody and karyotype of antinuclearantibody(ANA)in primary biliary cholangitis(PBC),autoimmune hepatitis(AIH)and overlap syndrome(PBC-AIH).MethodsThe data from 130 patients with PBC,82 patients with AIH and 84 patients with overlap syndrome hospitalizedin our hospital was collected from January 2019 to December 2021.ANA karyotype,anti-mitochondrial antibody(AMA),and anti-smooth muscle antibody(ASMA)were detected by indirect immunofluorescence.Anti-mitochondrial antibody M2(AMA-M2),anti-liver and kidney microsomal antibodyⅠ(LKM-1),anti-liver cytoplasmic antibodyⅠ(LC-1),anti-solubleliver antigen antibody(SLA),anti-nuclear membrane glycoprotein 210(gp210)and anti-soluble acid phosphorylatednuclear protein(sp100)were detected by Western blotting.ResultsThe karyotypes of ANA in PBC group were mainly ofcytoplasmic granular type,nuclear membrane type,mitochondrial type and centromere type.The positive rates of thesekaryotypes were significantly higher than those in the AIH group,but compared with the overlap syndrome group,only thepositive rate of nuclear membrane type was significantly higher(χ^(2)=8.61)(all P<0.05).The karyotypes of ANA in the AIHgroup were mainly granular type,homogeneous type and nucleolar type,and the positive rates were significantly higher thanthose in the PBC group(all P<0.05).The karyotypes of ANA in the overlap syndrome group were mainly of cytoplasmic granular type,linear granular type,nuclear dot type and nuclear membrane type.The positive rate was higher than those ofall the above karyotype in AIH group(all P<0.05).In terms of the positive rate of spectrum autoimmune antibody,thepositive rates of AMA,AMA-M2,gp210 and sp100 in the PBC group were significantly higher than of those in the AIHgroup;the positive rates of ASMA and SLA were lower than those in the AIH group,while the positive rate of AMA washigher than that of the overlap syndrome group(χ^(2)=14.21)(all P<0.05).ConclusionKaryotype of ANA combined withthe detection and analysis of spectrum of autoimmune antibody was helpful to improve the typing diagnosis of autoimmuneliver disease.