抗纤维肌动蛋白抗体阴性的自身免疫性肝炎Ⅰ型患者临床特征分析

The clinical features of autoimmune hepatitis type I patients with negative anti-filamentous actin antibody

目的探讨抗纤维肌动蛋白抗体(AFA)阴性的自身免疫性肝炎(AIH)I型患者的临床特点。方法收集194例AIH-I型患者临床资料,按照检测结果将患者分为AFA阳性组124例和AFA阴性组70例,另外收集197例健康献血者作为对照组。采用ELSIA法检测AIH-I型患者AFA、抗肝肾微粒体I型抗体(LKM-1)、抗可溶性肝抗原/胰抗原抗体(SLA/LP)、抗肝细胞溶质抗原I型抗体(LC-1),间接免疫荧光法检测抗核抗体(ANA)、抗平滑肌抗体(ASMA)。对AIH-I型患者作肝脏病理组织学检查和生化检测。统计学处理采用t检验、秩和检验和χ2检验。结果 AIH-I型患者中AFA阴性与阳性的男女人数和年龄比较差异无统计学意义(P>0.05),自身抗体ANA、ASMA、LKM-1、SLA/LP和LC-1检出率差异也无统计学意义(P>0.05),但AFA阴性比阳性患者的急性发病人数百分率高(34.29%比12.90%,P<0.01),血清ALT高[(146.32±20.87)U/L比(128.26±38.09)U/L,P=0.008]、AST高[(124.55±23.54)U/L比(97.62±45.26)U/L,P=0.004]、胆红素高[(42.57±14.17)μmol/L比(29.73±10.17)μmol/L,P=0.001]、免疫球蛋白G低[(18.42±5.11)g/L比(26.36±6.92)g/L,P<0.01]。肝组织病理检测可见AFA阴性比阳性患者的浆细胞浸润率高(35.71%比21.77%,P=0.03)、中央肝小叶3区坏死率高(41.43%比11.29%,P<0.01)。结论AIH-I型患者中AFA阴性比阳性患者的急性发病率高,血胆红素、ALT和AST升高,免疫球蛋白G降低,肝组织浆细胞浸润率、肝小叶3区坏死率升高。

Objective To investigate the clinical features of autoimmune hepatitis type I （AIH-I）patients with negative anti-filamentous actin antibody （AFA）.Methods A total of 194 AIH-I patients,including 124 positives （AFA≥30 U）and 70 negatives （AFA〈30 U）,were enrolled and 197 healthy blood donors were set as controls.Enzyme-linked immune-sorbent assay （ELISA）was conducted to measure AFA,anti-liver-kidney microsome autoantibody type 1 （LKM-1）,anti-soluble liver antigen/liver-pancreas （SLA/LP ） and anti-liver cytosol antibody type 1 （LC-1 ）.Antinuclear antibodies （ANA）and anti-smooth muscle antibodies （SMA）were detected by indirect immunofluorescence assay （IFA）. For statistically analyzing,liver biopsy of AIH-I patients and serum biochemical assessment of all research objects were performed.Results In AIH-I patients,no statistically significant differences in sex,age and positive rates of ANA, ASMA,LKM-1 ,SLA/LP and LC-1 were detected （P 〉0.05）between positive and negative group,respectively.Compared to those in AFA positive group,patients in AFA negative group had a significant higher percentage of acute onset （34.29% vs 12.90%,P 〈0.001）,higher serum levels of alanine aminotransferase （ALT）（146.32±20.87 U/L vs 128.26±38.09 U/L,P =0.008）,aspartate transaminase （AST）（124.55±23.54 U/L vs 97.62±45.26 U/L,P =0.004）and total bilirubin （TBil）（42.57±14.17 μmol/L vs 29.73 ±10.17 μmol/L,P =0.001 ）,while with a significant lower serum level of IgG （18.42±5.11 g/L vs 26.36±6.92 g/L,P 〈0.001）,respectively.Additionally,there were significantly higher incidences of plasma cell infiltration （35.71 % vs 21 .77%,P =0.03）and necrosis in central lobular zone 3 （41 .43% vs 11 .29%,P 〈0.001）in AFA negative group than those in AFA positive group.Conclusion Comparing to AFA positive patients with AIH-I,AFA negative patients displayed higher incidences of acute onset,plasma cell infiltration and necrosis in central lobular zone 3 with higher serum levels of TBil,ALT and AST but lower serum levels of IgG.