抗酿酒酵母细胞抗体在原发性胆汁性肝硬化患者中的临床意义

The clinical significance of anti-saccharomyces cerevisia antibody in primary biliary cirrhosis

目的 检测原发性胆汁性肝硬化（PBC）患者血清抗酿酒酵母细胞抗体（ASCA）,探讨其在PBC中的阳性状况和临床意义.方法 采用酶联免疫吸附试验（ELISA）检测162例PBC患者、44例自身免疫性肝炎（AIH）患者、41例肝病对照组（LDC）患者、144例炎症性肠病（IBD）患者及35名健康体检者血清ASCA的IgA和IgG亚型.采用χ2检验和非参数U检验进行分析.结果 ASCA-IgA在PBC患者中的阳性率为24.1%,高于溃疡性结肠炎（UC）组11.6%（χ2=5.5,P＜0.05）和健康对照组0（χ2=10.5,P＜0.01）,与AIH组（20.5%）、LDC组（14.6%）和克罗恩病（CD）组（34.5%）比较,差异无统计学意义（P＞0.05）;ASCA-IgG在PBC患者中的阳性率为11.1%,明显低于CD组27.6%（χ2=8.9,P＜0.01）,高于健康对照组0（χ2=10.5,P＜0.01）,与AIH组（15.9%）、LDC组（7.3%）和UC组（8.1%）比较,差异无统计学意义（P＞0.05）;ASCA-IgA和IgG同时阳性的PBC患者仅占6.2%,显著低于CD组17.2%（χ2=6.3,P＜0.05）;ASCA-IgA或IgG阳性的PBC患者占29.0%,显著低于CD组44.8%（χ2=4.8,P＜0.05）,高于UC组（χ2=5.9,P＜0.05）和健康对照组（χ2=13.3,P＜0.01）.抗GP210抗体阳性的PBC患者ASCA阳性率高于抗GP210抗体阴性PBC患者（38.6%和23.8%,χ2=3.9,P＜0.05）;抗线粒体抗体（AMA）、抗SP100抗体阳性和阴性PBC患者间ASCA的阳性率差异无统计学意义.ASCA-IgA阳性PBC患者总胆红素、直接胆红素、总胆汁酸、乳酸脱氢酶（LD）、IgA、IgM、红细胞沉降率（ESR）高于ASCA-IgA阴性PBC患者,而白蛋白（ALB）、白蛋白/球蛋白和胆碱酯酶低于ASCA-IgA阴性PBC患者（P均＜0.05）.ASCA-IgG阳性PBC患者与阴性患者间肝功能损伤指标和免疫功能指标差异均无统计学意义.结论 ASCA并不是IBD特异性自身抗体,在PBC患者有较高的阳性率,且以IgA亚型为主.ASCA-IgA与PBC患者肝功能损伤指标和免疫活动指标改变有关,而ASCA-IgG与PBC患者肝功能损伤指标和免疫活动指标改变无关.

Objective To explore the prevalence of the anti-saccharomyces cerevisiae antibody （ASCA） in patients with primary biliary cirrhosis and evaluate it＇s clinical significance. Methods The subtypes of ASCA including IgA and IgG in blood samples from 162 patients with PBC, 44 patients with AIH,4-1 patients with other non-autoimmune liver diseases controls （LDC）, 144 patients with inflammatory bowel disease （IBD） and 35 healthy controls were measured by ELISA. Chi-square test and Mann Whitney U test were used for statistical analysis. Results The positive rate of ASCA-IgA in PBC was 24.1%, which was higher than that in ulcerative colitis （UC） group （ 11.6%,χ2=5.5, P〈0.05 ） and healthy controls （0, χ2=10.5,P〈0.01 ）. Compared with the AIH group （20.5%） or LDC group （ 14.6% ） or Crohn＇s disease （CD） （34.5%）,there was no statistically significant difference （P〉0.05）. The prevalence of ASCA-IgG in PBC was 11.1%,lower than the CD group （27.6%, χ2=8.9, P〈0.01 ）, but higher than that in the healthy controls （0, χ2=10.5,P〈0.01 ）. There was no statistically significant difference （P〉0.05） between PBC and the AIH group （15.9%）or LDC group （7.3%） or UC group （8.1% ）. The positive rate of both ASCA-IgA and ASCA-IgG in PBC was only 6.2%, statistically lower than that of the CD group （ 17.2%, χ2=6.3, P〈0.05）. The prevalence of ASCA-IgA or ASCA-IgG in PBC was 29.0%, which was statistically lower than that of the CD group （44.8%, χ2=4.8,P〈0.05）, but higher than that of the UC group （χ2=5.9, P〈0.05） or healthy controls （χ2=13.3, P〈0.01）.ASCA was detected more frequently in PBC patients with positive anti-GP210 antibody than in anti-GP210 antibody negative PBC patients （38.6% vs 23.8%,χ2=3.9, P〈0.05）. The positive rate of ASCA between AMA positive and negative patients with PBC or anti-SP100 antibodies positive and negative patients with PBC was not significantly different. PBC patients with positive ASCA-IgA had higher level of TBIL, DBIL, TBA, LD,IgA, IgM, ESR and lower level of ALB, A/G, CHE than patients with negative ASCA-IgA. There was no statistically significant difference in liver injury indicators and immune function parameters between patients with positive ASCA-IgG and negative ASCA-IgG. Conclusion ASCA is not an IBD-specific antibody. There is a high prevalence of ASCA in patients with PBC, especially the subtype of ASCA-IgA. ASCA-IgA is found to be associated with the severity of liver damage and immune activity whereas ASCA-IgG is not associated with them.