原发性胆汁性肝硬化患者血清抗酿酒酵母抗体不同亚型的临床意义初探

Clinical significance of different subtypes of anti-saccharomyces cerevisia antibody in patients with primary biliary cirrhoses

目的 探讨原发性胆汁性肝硬化（PBC）患者血清中不同亚型的抗酿酒酵母抗体（ASCA）的临床意义.方法 采用酶联免疫吸附试验（ELISA）检测130例PBC患者、81例肝病（LDC组）患者、110例炎症性肠病（IBD组）及35例健康对照者血清ASCA的 IgA和IgG亚型.结果 PBC患者血清中ASCA-IgA亚型阳性率为22.3%,ASCA-IgG亚型阳性率10.0%;ASCA-IgA或ASCA-IgG亚型阳性率为26.9%;ASCA-IgA和ASCA-IgG亚型同时阳性率5.4%,PBC组患者ASCA-IgA或ASCA-IgG阳性率、ASCA-IgA阳性率与LDC、IBD组比较差异均无统计学意义（均P ＞0.05）,但与健康对照组比较差异有统计学意义（P＜0.05）;PBC组患者ASCA-IgA和ASCA-IgG同时阳性者阳性率、ASCA-IgG阳性率与LDC、IBD、健康对照组比较差异均无统计学意义（均P ＞0.05）,但ASCA-IgG亚型阳性率低于IBD组中的克罗恩病患者的22.0%（P＜0.05）.在PBC患者的AMA-M2和抗SP100抗体阴、阳性组中的ASCA-IgA、IgG亚型的检出率差异无统计学意义（P ＞0.05）,抗GP210抗体阳性组中的ASCA-IgA或IgG亚型检出率高于抗GP210抗体阴性组（P＜0.05）.ASCA-IgA阳性的PBC患者组中的TBil、IgA、IgM高于阴性组,ALB低于阴性组（P＜0.05）;ASCA-IgG阴、阳性组中的PBC患者的肝脏生化、免疫学指标均无统计学意义（均P ＞0.05）.结论 ASCA-IgA或ASCA-IgG可作为PBC患者的自身抗体在血清中存在,且ASCA-IgA 亚型与PBC的发病机制中存在一定的关系,并与PBC的预后有关.

Objective To investigate the subtypes of the anti-saecharomyces cerevisiae antibody （ASCA） in patients with primary biliary cirrhoses （PBC） and its clinical significance. Methods The subtypes of ASCA including IgA and IgG were detected by enzyme-linked immunosorbent assay （ELISA） in serum samples of 130 patients with PBC, 81 patients with liver diseases （LDC）, 110 patients with inflammatory bowel disease （IBD） and 35 healthy controls. Results The prevalence of ASCA-IgA or ASCA-IgG, ASCA-IgA and ASCA-IgG, ASCA-IgA, ASCA-IgG in PBC group was 26.9%, 5.4%, 22.3%, and 10.0%, respectively. The positive rates of ASCA-IgA or ASCA- IgG, ASCA-IgA in PBC were significant higher than those in healthy controls（P 〈0.05）, but there was no statistically significant difference compared with LDC group or IBD groups （P 〉0.05）. There was no difference in positive rate of ASCA-IgA and IgG, ASCA-IgG among all groups （P 〉0.05）. The positive rate of ASCA-IgG in PBC group was lower than that in Crohn＇s disease （CD） group （10.0% vs 22.0%, P〈0.05）. The positive rate of ASCA subtypes between AMA-M2 positive and negative patients with PBC or anti-SP100 antibodies positive and negative patients with PBC was not significantly different （P 〉0.05）. The positive rate of ASCA-IgA or IgG was more frequently in PBC patients with positive anti-GP210 antibody than that in anti-GP210 antibody negative PBC patients （P〈0.05）. PBC patients with positive ASCA-IgA have higher level of TBil, IgA, IgM and lower level of ALB than patients with negative ASCA-IgA. There were no statistically significant differences in liver function indicators and immune function parameters between patients with positive ASCA-IgG and negative ASCA-IgG. Conclusion The subtypes of ASCA are common in patients with PBC. It cannot be used as a specific serological marker for PBC but ASCA-IgA may help us to understand the mechanisms of the diseases.