自身免疫性肝炎患者抗中性粒细胞胞质抗体谱的检测

Clinical significance of detection of anti-neutrophil cytoplasmic antibodies in patients with autoimmune hepatitis

目的:探讨抗中性粒细胞胞质抗体谱(antineutrophil cytoplasmic antibodies,ANCAs)检测在自身免疫性肝炎(autoimmune hepatitis,AIH)患者的临床诊断价值,为AIH的相关研究提供临床依据.方法:对南昌大学第二附属医院2008-07/2012-03符合纳入标准的48例AIH、190例非-AIH患者及50例健康体检者采用ELISA法检测抗乳铁蛋白抗体(anti-lactoferrin antibody,ALA)、抗蛋白酶3抗体(抗-PR3)和抗髓过氧化物酶抗体(抗-MPO),免疫荧光法检测ANCAs,回顾性分析检测结果.结果:(1)AIH组ANCA、p-ANCA、x-ANCA及ALA阳性率与非-AIH各组(PSC除外)比较有统计学意义,抗-MPO阳性率为54.2%,与非AIH各组比较均有P<0.01;(2)所有标本中仅AIH组有1例同时c-ANCA、抗-PR3阳性,虽对诊断AIH特异性高但无临床价值;(3)配对2检测,抗-MPO与ANCA、p-ANCA,ALA与x-A N C A对A I H的诊断无统计学意义;一致性分析,抗-MPO与ANCA、p-ANCA值为0.819、0.875,一致性极好.结论:ANCAs抗体间存在一定的相关性,联合检测可提高AIH的诊断率,对AIH患者的临床鉴别、诊断有重要意义.

AIM： To explore the significance of detection of anti-myeloperoxidase antibody （ANCAs） in the diagnosis of autoimmune hepatitis （AIH）. METHODS： In total, 48 AIH patients, 190 non- AIH patients and 50 healthy volunteers wereincluded in this retrospective study. Enzyme- linked immunosorbent assay （ELISA） was used to detect anti-RP3, anti -MPO and ALA, while indirect immunofluorescence （IIF） was em- ployed to detect ANCAs. RESULTS： The positive CA, x-ANCA and ALA rates of ANCA, p-AN- in the AIH group had significant differences compared with the non- AIH group （except for PSC）. The positive rate of anti-MPO was significantly higher in the AIH group than in the non-AIH group （P 〈 0.01）. Of all specimens in the AIH group, only 1 was positive for c-ANCA and PR3 simultane- ously. There was a good correlation between anti-MPO and ANCA, between anti-MPO and p-ANCA, and between ALA and x-ANCA in the AIH group. The kappa values of anti-MPO and ANCA as well as anti-MPO and p-ANCA were 0.819 and 0.875, respectively, showing ex- cellent agreement. CONCLUSION： Combined detection of ANCAs is helpful for the diagnosis of AIH and AIH sub- types.