AMA-M2阳性的原发性胆汁性肝硬化患者生物化学指标特点分析

Biochemical characteristics of primary biliary cirrhosis patients with positive antimitochondrial antibody M2 subtype

目的分析抗线粒体M2亚型抗体阳性(AMA-M2)的原发性胆汁性肝硬化(primary biliary cirrhosis,PBC)患者生物化学指标特点,为临床PBC诊治提供帮助。方法对本院2010年8月-2012年3月280例AMA-M2阳性的PBC患者分别检测血清蛋白、脂类、胆红素及酶类等16项血清生物化学指标。采用毛细电泳技术,分析患者6种血清蛋白变化情况。采用光电比色法和发色(吸光度)法分别检测患者WBC、RBC、HGB、PLT以及PT等临床血液学指标。采用魏氏法检测患者血沉变化。结果生化指标检测结果显示,血清蛋白及脂类以ALB、TC异常率最高,分别为52%、40%。超过50%的患者出现酶类及胆红素代谢结果异常,异常率由高到低分别为GGT(96%)、ALP(93%)、TBA(81%)、AST(73%)、DB(66%)、CHE(66%)、LAP(63%)、ALT(61%)、TB(54%),其中以DB、GGT、TBA变化幅度最高[≥2倍正常值上限(ULN)],其次为ALP、TB、ALT、AST(1倍ULN),LAP低于1倍ULN。患者血清蛋白电泳结果异常主要体现在γ球蛋白和白蛋白百分比,异常率分别为71%和57%,且前者出现低于1倍ULN升高。近半数患者出现临床血液学指标变化,异常率由高到低是:ESR、HGB、RBC、PT、PLT、WBC,其中以ESR的异常率最为突出84%,其余依次为HGB(49%)、RBC(46%)、PT(44%)、PLT(41%)、WBC(39%),变化幅度以ESR最高(1倍ULN),其次为RBC、HGB、PT(≤1倍ULN)。结论 PBC患者血清蛋白和脂类、酶类和胆红素代谢以及血清蛋白分布等多种生化指标变化特点,结合临床血液学特点,将为PBC的临床诊断提供重要帮助。

Objective To provide the reference for the diagnoisis and treatment of primary biliary cirrhosis（PBC） by studying the biochemical characteristics of PBC patients with positive anti-mitochondrial antibody M2 subtype（AMA-M2）.Methods Two hundred and eighty PBC patients with positive AMA-M2 admitted to our hospital from August 2010 to March 2012 were included in this study.Their 16 serum biochemical indexes such as serum protein,lipid,bilirubin and enzymes were tested.Six kinds of serum proteins were analyzed by capillary electrophoresis.WBC,RBC,HGB,PLT and PT were calculated by photoelectric colorimetry and chromophoremetry（absorbency）,respectively.Sedimentation was measured by Western method.Results Biochemical analysis showed that the percentage of abnormal serum protein and lipid（ALB,TC） was 52% and 40%,respectively.The metabolism of enzymes and bilirubin was abnormal in more than 50% of the patients.The percentage of abnormal GGT,ALP,TBA,AST,DB,CHE,LAP,ALT,and TB was 96%,93%,81%,73%,66%,66%,63%,61%,54%,respectively.The DB,GGT,and TBA were 2-fold higher than the ULN.The ALP,TB,ALT,and AST were 1-fold higher than the ULN.The LAP was 1-fold lower than the ULN.Capillary electrophoresis showed that the percentage of abnormalγ-globulin and albumin was 71% and 57%,respectively,and was l-fold lower than the ULN.The abnormal clinical hematology indicators were found in more than 50% of the patients.Tthe percentage of abnormal ESR,HGB,RBC,PT,PLT,and WBC was 84%,49%,46%,44%,41%,and 39%,respectively.The percentage of abnormal sedimentation was 84%（1-fold higher than the ULN）.The percentage of abnormal RBC,HGB,and PT was≤1-fold of the UNL.Conclusion Features of a variaty of biochemical indexes such as serum protein,lipid,metabolism of bilirubin and enzyme,distribution of serum protein molecules in combination of clinical hematological test contribute greatly to the clinical diagnosis of PBC.