原发性胆汁性肝硬化患者自身抗体检测及其临床意义

Detection and significance of auto-antibodies in patients with primary biliary cirrhosis

目的探讨血清自身抗体对原发性胆汁性肝硬化(PBC)的诊断及其临床意义。方法对PBC患者采用间接免疫荧光、免疫印迹法检测抗核抗体(ANA)、抗平滑肌抗体(SMA)、抗线粒体抗体(AMA),并对AMAM2亚型及其抗可溶性肝抗原/肝胰抗原(SLA/LP)、抗肝肾微粒体Ⅰ型(LKM-1)和抗肝特异性胞浆Ⅰ型抗体(LC-1)等肝脏疾病相关的自身抗体进行检测。结果PBC患者自身抗体以AMA和AMAM2亚型为主。其阳性率分别为96.5%和93.1%。患者的抗体滴度均大于1∶100,其中有8例出现ANA和SMA,1例出现AMA和SLA/LP同时阳性,表现与Ⅰ型和Ⅲ型自身免疫性肝炎重叠,另有19例AMAM2阳性患者进行肝穿病理检查时,12例(63.7%)患者病理提示符合PBC诊断。结论自身抗体对PBC有诊断意义,注重自身抗体的检测对明确自身免疫性肝病有重要的临床意义。

Objective To study the role of auto-antibody in the diagnosis of patients with PBC. Methods ANA,SMA and AMA in serum of primary bi/iary cirrhosis（PBC） were tested by indirect immune fluorescence and western blot. Such auto-antibodies as Anti-type AMAM2, anti-SLA/LP, anti-LKM-1 and anti-LC-1 were also identified. Results Auto-antibodies existing in patients with PBC were mainly AMA （96.5 % ） and AMAM2 （93.1% ） and the titer was above 1 ： 100.8 cases of those patients were positive with ANA and SMA simultaneously. One case had positive AMA and SLA/LP in serum and the clinical appearances were the same as those of type Ⅰ and type Ⅲ autoimmune hepatitis. 19 patients with positive AMAM2 in serum had liver-puncture and the results suggested the diagnosis of PBC in 63.7% （ 12/ 9）. Conclusion Test of auto-antibodies is clinically significant for the diagnose of autoimmune hepatitis.