抗线粒体抗体-M2阳性体检人群原发性胆汁性肝硬化相关指标的调查分析

Evaluation of markers associated with primary biliary cirrhosis in a population of anti-mitochondrial antibody-M2-positive individuals

目的一通过对抗线粒体抗体（AMA）-M2型阳性体检人群原发性胆汁性肝硬化（PBC）相关指标的分析，揭示PBC早期主要临床症状及体征的分布状况。方法对20970例健康体检者进行调查，采用间接免疫荧光法检测抗核抗体（ANA），采用免疫印迹法检测AMA-M2。率的比较用x2检验，P〈0.05为差异有统计意义。结果ANA滴度〉1：320。阳性l243例，其中AMA-M2阳性156例，阳性率0.74％，男性阳性率为0.3％（32／10550），女性阳性率为1.2％（124／10420），二者差异有统计学意义（x2=55.85，P〈0.05）；肝功能异常66例，其中碱性磷酸酶升高58例，可明确诊断为PBC；血常规异常72例；有胆囊疾病病史者47例，糖尿病史者49例，过敏史者22例；有腹部不适者75例，乏力者38例，黄疸者3例，瘙痒者11例。与对照组比较，差异均有统计学意义。结论亚健康人群如发现血常规及肝功能异常应尽早行AMA-M2等自身抗体检测，以利于PBC早期诊断及病情控制，提高患者生活质量，延长寿命。

Objective To explore the distribution of the main clinical symptoms and signs of primary biliary cirrhosis （PBC） in a population of individuals with positivity for anti-mitochondrial antibody-M2 （AMA-M2）. Methods A total of 20 970 persons who participated in routine health examinations at our hospital were tested for presence and level of antinuclear antibodies （ANAs） using an indirect immunofluorescence （IIF） assay and of AMA-M2 by westem blotting. The chi-square test was used for statistical-analysis. Results Titers of ANAs 〉1：320 were detected in 1 243 of all the study participants, with 156 of those individuals having detectable AMA-M2. The overall rate ofAMA-M2 positivity was 0.74%, with a significantly higher rote among female subjects （males： 0.3% （32/10 550） vs. females： 1.2% （124/10 420）;x2= 55.85, P 〈 0.05）. Among the AMA-M2-positive population there were 66 cases of abnormal liver function, 58 cases of increased alkaline phosphatase, 72 cases of abnormal findings for routine blood testing, 47 cases of gallbladder disease history, 49 cases of diabetes history, 22 cases of aUergy, 75 cases of abdominal discomfort, 38 cases of weakness, 3 cases of jaundice, and 11 cases of pruritus. There were significant differences between the AMA-M2-negative individuals and the AMA-M2-positive individuals. Conclusion Among the general population, individuals with substandard states of health, such as those with abnormal findings in routine blood tests and abnormal liver function, should be screened for AMA-M2. This screening will facilitate early diagnosis of PBC and timely initiation of disease management, improving the patient＇s life quality of life and prolonging their life.