自身免疫性肝病抗体在肝病诊断中的临床价值

Clinical value of antibodies of autoimmune liver disease in diagnosing liver diseases

目的探讨自身免疫性肝病抗体在肝病诊断中的临床价值。方法回顾性分析2145例肝病患者的自身抗体结果,并对自身抗体阳性的结果进行临床分析。结果 2145例患者中共检测出自身抗体阳性359例,阳性率为16.7%。诊断原发性胆汁性肝硬化(PBC)64例,检出率为3.0%,诊断自身免疫性肝炎(AIH)59例,检出率为2.8%。73.4%PBC患者血清抗核抗体(ANA)≥1∶320,且26.6%抗线粒体抗体(AMA)为阳性;49.2%AIH患者血清ANA≥1∶320,且3.3%AMA为阳性。PBC患者核膜型及着丝点型显著多于AIH患者,而均质型及着丝点颗粒型显著少于AIH患者,差异均有统计学意义。ANA阳性≥1∶320乙型肝炎患者谷丙转氨酶(ALT)、谷草转氨酶(AST)、谷酰转肽酶(GGT)及碱性磷酸酶(ALP)水平显著高于ANA阳性≥1∶100及ANA阴性患者,差异有统计学意义。结论自身抗体检测是诊断自身免疫性肝病的必要条件,但需鉴别病毒性肝炎、药物性肝炎和其他疾病。

Objective To explore clinical value of antibodies of autoimmune liver disease in diagnosing liver diseases.Methods The resultsof autoantibodiesin 2145 patients with liver diseases were retrospectively analyzed, and the positive results of autoantibodies were further analyzed in the research. Results Positive autoantibodies were detected in 359 patients with 16.7% positive rate.There were 64 patients diagnosed as primary biliary cirrhosis（PBC）and 59 patients as autoimmune hepatitis（AIH）and the diagnosis rates were 3.0% and 2.8% respectively. The ratio of anti- nuclear antibody（ANA）in serum that was more than 1∶320 was found in 73.4% patients with PBC,and the anti- mitochondrial antibody（AMA）was positive in 26.6% patients. The ratio of ANA in serumthatwasmorethan1∶ 320wasfoundin49.2%patientswithAIH,anditdetectedthat3.3%AMA was positive. Type of Karyolemma in the patients with PBC were more than the type of centromere in the patients with AIH while patients with homogeneous and centromere granular types were markedly less than the patientswith AIH. Therefore, the difference was statistical significant.The levels of alanine transaminase（ALT）, aspartate aminotransferase（AST）, gamma- glutamyl transpeptidase（GGT）and alkaline phosphatase（ALP）in hepatitis B patients with positive ANA that was more than 1∶320 were markedly higher than the patients with positive ANA that was more than 1∶ 100 and negative patients with ANA. Therefore, difference was statistically significant.Conclusion Autoantibody detection is necessary to diagnose autoimmune liver diseases. However,the diagnosis of viral hepatitis, drug hepatitis and other diseases need to be differed from that of autoimmune liver disease.