自身抗体与生化指标联合检测在自身免疫性肝炎诊断中的意义

The significance of autoantibodies in diagnosing autoimmune hepatitis

目的:探讨自身抗体和各项生化指标在自身免疫性肝炎诊断中的意义。方法:对109例患者采用间接免疫荧光法及免疫印迹法进行自身抗体(ANA、SMA、LKM-1、LC-1、SLA/LP)的检测,结合其生化指标(ALT、AST、GGT、ALP、TBA)进行分析。并将109例患者按国际评分标准计算的积分以>15分组和?15分组两组,进行积分、血清抗体和诊断的相关性分析。结果:109例ANA抗体异常患者中AIH23例,其中血清抗体阳性的患者有20例,血清抗体诊断AIH的灵敏度为87%,特异度为86.7%,诊断AIH的阳性预测值为73.5%。疾病组的生化指标ALT,AST,GGT,TBA与对照组比较差别有统计学意义(P<0.05),并以其为自变量,AIH为因变量进行Logistic回归统计,入选的是ALP和GGT。血清抗体与诊断的相关性分析表明呈正相关(r=0.237,P<0.05),积分与诊断也呈正相关(r=0.745,P<0.01)。结论:自身抗体在AIH的诊断中有较高特异性。生化指标ALT,AST,TBA在AIH组中有明显降低,而GGT明显升高。在AIH的诊断中有一定的临床意义。

Objective：To study the significance of autoantibodies and the biochemical indicators in the diagnosis of autoimmune hepatitis.Methods： To analyze autoantibodies（ANA,SMA,LKM-1,LC-1,SLA/LP） and biochemical markers（ALT,AST,GGT,ALP,TBA） in 109 patients with abnormal liver function.Then apart all samples to two groups by Scoring system and analyze the correlation： scoring and autoantibodies with diagnosis.Results： of these 109 patients with liver diseases,23 were diagnosed AIH.,of which 20 were serum antibody-positive,sensitivity and specificity of the serum antibody in diagnosing AIH were 87% and 86.7% respectively,and the positive predictive value was 73.5%.Patients′ biochemical indicators： ALT,AST,GGT,TBA with the control group,the differences were statistically significant（P0.05）.In multivariate analysis the factors（ALT,AST,ALP,GGT,TBA） with AIH were ALP and GGT.The correlation analysis of Serum antibodies and scoring with diagnosis showed that was positively correlated.Conclusion： Autoantibodies is highly specific for diagnosing AIH,which is an important basis for the diagnosis of AIH.Biochemical indicators of ALT,AST,ALP,GGT,TBA in AIH have increased significantly in the diagnosis of AIH which have some clinical significance.