134例自身免疫性肝病患者自身抗体的分析

Detection of Autoantibodies in Patients with Autoimmune Liver Disease

目的:探讨自身免疫性肝脏疾病的自身抗体特征,以提高对该病的认识。方法:在134例患者中,原发性胆汁性肝硬化(PBC)73例,自身免疫性肝炎(AIH)43例,原发性硬化性胆管炎(PSC)4例,乙型病毒性肝炎(HBV)3例,丙型病毒性肝炎(HCV)6例,非甲￣戊型病毒肝炎(NonA-E)5例。采用间接免疫荧光法、免疫印迹法等分别检测抗核抗体(ANA)、抗线粒体抗体(AMA)、抗肝肾微粒体抗体Ⅰ型(LKM-1)、抗可溶性肝抗原/肝胰抗原(SLA/LP)和AMA-M2亚型等。结果:6例LKM-1阳性,6例SLA/LP阳性,分别见于AIH、AIH/PBC重叠综合征和HCV患者。PBC患者AMA和AMA-M2阳性率为94.5%,ANA阳性率为90.4%,以胞浆型为主(32/66)。AIH患者的ANA阳性率为90.7%,以核膜型为主(19/39)。非甲￣戊组,2例AMA和AMA-M2阳性,1例SMA阳性。结论:检测自身抗体有助于该病的诊断,临床不能忽视肝功能异常的患者,诊断时应考虑可能患有自身免疫性肝病。

Objective： To study the characteristics of autoantibodies in autoimmune liver diseases and to improve its recognition. Methods： One hundred and thirty four patients were included in this study, among them 73 patients with primary biliary cirrhosis （PBC）, 43 patients with autoimmune hepatitis （AIH）, 4 patients with primary sclerosing cholangitis （PSC）, 3 patients with hepatitis B （HBV）, 6 patients with hepatitis C （HCV） and 5 patients with hepatitis non AE （Non A-E）. Antinuclear antibodies （ANA）,antimitochondrial antibodies （AMA）,antismooth muscle antibodies （SMA） and anti-liver-kidney microsomal antibody type 1（LKM-1） were tested by indirect immunofluorescence. LKM-1, soluble liver antigen/liver pancreas （SLA/LP） and subtype of AMA （M2） were detected by Western blot analysis. Results： Positive LKM-1 and positive SLA/LP were detected in 6 cases with AIH, AIH/PBC overlap syndromes and HCV infection respectively. AMA and M2 showed a positive rate of 94.5% in PBC. ANA showed a positive rate of 90.4% with main ANA pattern of cytoplasm components （32/66）. ANA were 90.7% positive in AIH patients, and its main ANA pattern was nuclear membrane（19/39）. AMA and AMA-M2 were positive in 2 cases in Non AE group. One case in NonA-E group had high titer of SMA. Conclusion： The detection of autoantibodies is helpful for the diagnosis of autoimmune liver diseases. Autoimmune liver diseases should be considered when patients with abnormal liver functions.