自身抗体联合检测在原发性胆汁性肝硬化诊断中的意义

Significance of combined analysis of autoantibodies in diagnosis of primary biliary cirrhosis

目的探讨不同抗体联合检测在原发性胆汁性肝硬化(PBC)诊断中的意义。方法随机选择灵台县妇幼保健站2010年7月-2013年7月收治的肝病患者245例,根据患者所患疾病种类不同,将患者分为PBC组(n=162)、自身免疫性肝炎(AIH)组(n=42)和其他肝病患者(LDC)组(n=41)。采用ELISA法检测血清抗线粒体抗体M2亚型(AMA-M2)、抗SP100以及GP210抗体,采用Western Blot检测法检测血清中抗可溶性肝抗原(抗SLA)抗体,采用间接免疫荧光法检测血清抗线粒体抗体(抗AMA)。组间抗体阳性率的比较采用χ2检验和Fisher's检验。结果 PBC患者的AMA、AMA-M2、抗GP210的阳性率分别是93.21%、87.65%、19.75%,高于AIH患者的19.05%、7.14%、9.52%,差异具有统计学意义(χ2=97.311,P=0.001;χ2=98.264,P=0.001;χ2=10.312,P=0.012)。PBC患者的AMA、AMA-M2及抗GP210的阳性率分别为93.21%、87.65%、19.75%,LDC患者的阳性率分别为9.76%、2.44%、7.32%,PBC患者明显高于LDC患者,差异具有统计学意义(χ2=142.745,P=0.003;χ2=112.574,P=0.002;χ2=15.217,P=0.042)。结论 AMA对PBC的诊断具有标志性意义,抗SP100对PBC的疾病进展具有提示作用,抗GP210对阴性PBC患者具有诊断作用。

Objective To evaluate the significance of combined analysis of different autoantibodies in the diagnosis of primary biliary cirrho- sis （PBC）. Methods Two- hundred and forty -five patients with liver diseases were randomly selected. According to the disease type, patients were divided into PBC group （n = 162） , autoimmune hepatitis （AIH） group （n = 42 ） , and liver disease control （LDC） group （n=41 ）. ELISA assay was used to detect serum anti - mitochondrial antibody （ AMA - M2） and antibodies against SP100 and GP210. Western blot assay was employed to detect serum anti - SLA antibodies. Indirect immunofluorescence assay was performed to detect serum AMA. Comparison of antibody positive rates between groups was carried out using the chi - square test and Fisher＇s test. Results Serum AMA, AMA- M2, and anti- GP210 positive rates of the PBC group were 93.21% , 87.65% , and 19.75% , respectively, significantly higher than those of the AIH group, i. e. , 19.05%, 7.14%, and 9.52% , respectively （χ^2 = 97. 311, P =0. 001 ;χ^2 = 98. 264, P = 0. 001 ; χ^2 = 10. 312, P =0. 012）. The AMA, AMA - M2, and anti - GP210 positive rates of the PBC group were also significantly higher than those of the LDC group, i. e. , 9.76%, 2.44%, and 7.32%, respectively （χ^2 = 142. 745, P = 0. 003 ; χ^2 = 112. 574, P = 0. 002 ; χ^2 = 15. 217, P = 0. 042）. Conclusion Serum AMA has a remarkable meaning to PBC diagnosis, anti - SP100 gives a hint of PBC progres- sion, and anti -GP210 plays a role in the diagnosis of AMA-negative PBC.