上海地区体检者中筛查M2型抗线粒体抗体的阳性率分析

Analysis on the positive rate of M2 anti-mitochondrial antibodies in physical examine screening in Shanghai

目的通过分析成年体检者M2型抗线粒体抗体(AMA-M2)的阳性率情况,评价AMA-M2对原发性胆汁性肝硬化(PBC)早期筛查的价值。方法收集健康体检人群血清样本6 658例,其中男3 845例,女2 813例,男女比例为1.37∶1,年龄(46±13)岁。采用酶联免疫吸附试验(ELISA)定量检测AMA-M2,并与血清丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、碱性磷酸酶(ALP)和γ-谷氨酰基转移酶(GGT)检测结果同时分析。结果在6 658名健康体检者中AMA-M2阳性97例(1.46%),其中男性和女性分别为44例(1.14%)和53例(1.88%),男女之比为1∶1.2;≥46岁的女性AMA-M2阳性率高于<46岁的女性(P<0.01),97例AMA-M2阳性且无任何疾病包括PBC相关临床症状者中有8例伴ALP升高,GGT也升高。结论对健康体检者应高度重视AMA-M2与ALP/GGT甚至ALT与AST的关联分析,AMA-M2筛查是高危人群早期发现PBC的有效途径,按照美国肝脏病学会(AASLD)PBC诊疗指南的诊断标准监测AMA-M2阳性体检者的AMA-M2和肝脏血清酶水平有助于提高PBC的早诊率。

Objective To investigate the early screening significance of M2 anti-mitochondrial antibodies（AMA-M2）for primary biliary cirrhosis（PBC） in physical examine,through analyzing the positive rate of AMA-M2.Methods Serum samples were collected from 6 658 healthy subjects（3 845 males and 2 813 females）,and the sex ratio was 1.37 ∶ 1.Their age was 46 ± 13.AMA-M2 was quantitatively determined by enzyme-linked immunosorbent assay（ELISA）.Serum alanine aminotransferase（ALT）,aspartate aminotransferase（AST）,alkaline phosphatase（ALP） and gamma glutamyltransferase（GGT） were determined,and the results were analyzed cemparatively.Results AMA-M2 were detected in 97 of 6 658 healthy subjects（1.46%）,including 44 males（1.14%） and 53 females（1.88%）,and the sex ratio was 1 ∶ 1.2.AMAM2 positive rate of females above 46 years old was higher than those below 46 years old（P 0.01）.The 8 of 97 AMA-M2 positive cases without PBC clinical feature had increasing ALP and GGT.Conclusions Physical examination should pay attention to the correlation analysis of AMA-M2 with ALP / GGT and ALT with AST.AMA-M2 screening is an effective mean to high risk population in the early detection of PBC.According to American Association for the Study of Liver Disease（AASLD） PBC liver disease diagnostic criteria,positive AMA-M2 and serum liver enzyme help with improving the early detection rate of PBC.