慢性肝病自身抗体的检测及其与自身免疫性肝病的相关性

Detection of Autoantibodies in Chronic Liver Disease and Its Correlation with Autoimmune Liver Diseases

目的研究慢性肝病患者中自身免疫性肝病存在状况、自身抗体检测的阳性率及其临床意义。方法选择2001年1月至2005年5月同济医院慢性肝病住院患者共367例,包括慢性乙型肝炎124例、慢性丙型肝炎45例、自身免疫性肝病122例及其它76例,采用间接免疫荧光法、免疫条带法、ELISA法检测自身抗体和自身抗体亚型。结果367例慢性肝病患者自身免疫性肝炎(AIH)、原发性胆汁性肝硬化(PBC)、原发性硬化性胆管炎(PSC)及AIH/PBC重叠综合征(overlap syndrome)所占比例分别为9.81%、10.90%、7.63%及4.90%。抗核抗体(ANA)、抗线粒体抗体(AMA)及AMA-M2、核周型抗中性粒细胞胞质抗体(pANCA)检出阳性率各病例组组间比较差异有显著性意义(P<0.01或P<0.05)。抗肝肾微粒体抗体1型(anti-LKM1)、抗可溶性肝抗原/肝胰抗原(anti-SLA/LP)抗体检出阳性率分别为5.73%、4.1%。未检出抗肝细胞溶质抗原1型抗体(anti-LC-1)。自身抗体总阳性率为20.41%。慢性病毒性肝炎患者ANA检测阳性组AST、TBil与ANA阴性组比较,差异有显著性意义(均P<0.05)。结论自身抗体与肝损伤程度有一定相关性。自身抗体及肝抗原自身抗体的检测是提高自身免疫性肝病检出率的有效途径。

Objective To investigate the positive rate of autoantibodies and autoimmune liver diseases in patients with chronic liver diseases and its clinical significance. Methods Three hundred and sixty seven patients with abnormal liver function were chosen and divided into 4 groups： chronic hepatitis B （HBV） group; chronic hepatitis C （HCV） group; autoimmune liver diseases （AID） group; other group. Anti-nuclear antibody （ANA）, anti smooth muscle antibody （SMA）, anti-mitochondral antibody （AMA）, perinuclear anti-neutrophil cytoplasmic antibodies （pANCA） and cANCA were tested by indirect immuno fluorescence. Ant-liver/kidney microsomal type 1 （anti LKM-1）, anti-soluble liver antigen/live pancreatic antigen （anti-SLA/ LP）, antibody to liver cytosol type 1 （anti LC-1） and subtype 2 of AMA （M2） were tested by Western blot. Results In these 367 cases, 9.81%, 10.90 %, 7.63 % and 4.90 % were diagnosed as having PBC, AIH, PSC and AIH/PBC respectively. There was significant difference in the positive rate of ANA, AMA, M2 and pANCA among the groups. The overall positive rate of autoantibodies was 20.41%. The serum levels of AST and TBIL in HBV ANA positive group were significantly higher than in ANA negative group （P^0.05）. Conclusion The detection for autoantibodies to liver antigens, ANA, pANCA, cANCA, AMA and subtype 2 of AMA is helpful for diagnosis and differential diagnosis of autoimmune liver diseases.