自身抗体检测对肝病患者的鉴别诊断价值

The value of autoantibodies in differential diagnosis of patients with liver diseases

目的探讨自身抗体检测在鉴别诊断自身免疫性肝病(autoimmune liver disease,ALD)与慢性乙型肝炎(chronic hepatitis B,CHB)患者中的价值。方法回顾性分析2011年5月-2014年8月经枣阳市第一人民医院确诊的ALD患者215例,其中自身免疫性肝炎(AIH)患者122例,原发性胆汁性肝硬化(PBC)患者93例,同时选取CHB患者453例,采用间接免疫荧光法和免疫印迹法检测ANA、AMA、SMA、抗SLA/LP、抗LKM-1、抗LC-1及AMA-M2。比较3组患者的ALT、AST、ALP、GGT水平。结果 AIH组、PBC组患者的ALT、AST、ALP、GGT含量高于CHB组,差异有统计学意义(P<0.05);ALD患者ANA总阳性率为83.26%,高于CHB组(15.01%)(P<0.05);AIH组ANA、AMA、SMA、抗SLA/LP、抗LKM-1、抗LC-1及AMA-M2阳性率分别为79.51%、14.75%、45.90%、16.39%、12.30%、6.565%、3.28%;PBC组ANA、AMA、SMA、抗SLA/LP、AMA-M2阳性率分别为88.17%、94.62%、11.83%、3.23%、94.62%;AIH组和PBC组ANA阳性检出率显著高于CHB组(P<0.05)。AIH组和PBC组ANA滴度大于1∶320的比率显著高于CHB组(P<0.05)。结论自身抗体检测是诊断ALD的必要条件,对ALD和CHB的鉴别诊断有重要临床意义。

Objective To investigate the value of autoantibodies in differential diagnosis of autoimmune liver disease （ALD） and chronic hepatitis B （CHB） patients. Methods Two hundred and fifteen cases of ALD in the First People＇ s Hospital of Zaoyang City from May. 2011 to Aug. 2014 were retrospectively analyzed, included 122 cases of autoim- mune hepatitis （AIH） and 93 cases of primary biliary cirrhosis （PBC）. Four hundred and fifty-three cases of CHB pa- tients were selected at the same period. ANA, AMA, SMA, anti-SLA/LP, anti-LKM-1, anti-LC-1, and AMA-M2 were measured by indirect immunofluorescence and immunoblotting. The levels of ALT, AST, ALP, and GGT were compared among three groups. Results The levels of ALT, AST, ALP, GGT in AIH group and PBC group were significantly higher than those in CHB group （15.01%） （P 〈0.05）. ANA total positive rate was 83.26% in ALD patients, signifi- cantly higher than CHB group （P 〈0.05）. The positive rates of ANA, AMA, SMA, anti-SLA/LP, anti-LKM-1, anti- LC-1, and AMA-M2 were 79.51%, 14.75%, 45.90%, 16.39%, 12.30%, 6.565%, 3.28% in AIH group. The positive rates of ANA, AMA, SMA, anti-SLA/LP, and AMA-M2 were 88. 17% , 94. 62% , 11. 83% , 3.23% , 94.62% in PBC group. The positive rate of ANA in AIH group and PBC group was significantly higher than that in CHB group （P 〈 0.05）. The rate of ANA titer greater than 1 ： 320 was significantly higher in AIH group and PBC group than that in CHB group （P 〈 0.05）. Conclusion Autoantibodies detection is a necessary condition for the diagnosis of ALD, it plays an important role in differential diagnosis of ALD and CHB.