原发性胆汁性肝硬化合并自身免疫性疾病患者免疫学指标及补体水平研究

Research on immune index and complement level in patients with primary biliary cirrhosis combined with autoimmune disease

目的分析原发性胆汁性肝硬化(PBC)合并自身免疫性疾病患者免疫指标及补体水平变化,探讨其与病情评估及诊断的临床意义。方法收集PBC患者85例作为研究对象,根据是否合并其他免疫自身疾病分为PBC组46例,PBC合并自身免疫疾病组39例。其中PBC合并干燥综合征(SS)8例、甲状腺炎22例、系统性红斑狼疮3例、类风湿关节炎(RA)6例。并随机抽取健康对照组50例,检测三组免疫指标、补体水平并进行比较,并对PBC合并自身免疫疾病组免疫指标及补体水平与肝功能指标(TBIL)及凝血酶原活动度(PTA)进行相关性分析。结果 PBC组、PBC合并自身免疫疾病组及对照组在免疫球蛋白G(IgG)、免疫球蛋白M(IgM)、免疫球蛋白A(IgA)、CD4^+、CD8^+、自然杀伤细胞(NK)、C3、C4方面比较差异均有统计学意义(P<0.05),其中PBC合并自身免疫疾病组的IgG、IgM、IgA、CD4^+水平最高,CD8^+、NK、C3、C4水平均为最低。三组CD4^+/CD8^+水平比较,差异无统计学意义(P>0.05)。对PBC合并自身免疫疾病组免疫指标及补体水平与TBIL及PTA进行相关性分析,发现IgG、IgM均与TBIL呈正相关(P<0.05),C3、C4均与TBIL呈负相关(P<0.05)。IgG、IgM、IgA、CD4^+均与PTA呈负相关(P<0.05),CD8^+、NK、C3、C4均与PTA呈正相关(P<0.05)。结论原发性胆汁性肝硬化合并自身免疫疾病患者的免疫指标(IgM、IgG、IgA、CD4^+、CD8^+、NK)和补体(C3、C4)水平在其病程中的变化体现了重要的相关性,联合检测免疫指标、补体,以及其与TBIL及PTA相关分析对于其病情评估和诊断有重要的临床意义。

Objective A total of 85 cases of PBC patients were collected as the research objects ,and according to whether the patients combined other autoimmune diseases ,46 cases with PBC were divided in to PBC groups ,and 39 cases were divided into PBC with autoimmune diseases group .There are 8 cases of PBC with sjogren syndrome （SS） ,22 cases combined with thyroiditis , 3 cases combined with systemic lupus erythematosus and 6 cases combined with rheumatoid arthritis （RA） .And 50 cases of health‐y people were randomly selected as the control group .Immune index and complement level were analyzed between the three groups .And the correlation analysis between the immune index ,complement level ,totalbilirubin （TBIL） ,and prothrombin time activity （PTA） in PBC and autoimmune disease combination group .Methods Differences of the levels of IgG ,IgM ,IgA ,CD4＋ , CD8＋ ,Natural Killer （NK） ,C3 and C4 between PBC group ,PBC autoimmune disease combination group and control group had statistical significance （P〈0 .05） .In PBC and autoimmune disease combination group ,the level of IgG ,IgM ,IgA and CD4＋ were the highest ,and level of CD8＋ ,NK ,C3 and C4 were the lowest .Differences of CD4＋ /CD8＋ between the three groups had no sta‐tistical significance （P〉0 .05） .By analyzing the correlation of the immune indexes and complement levels with TBIL and PTA in the group of PBC autoimmune disease ,the results showed that both IgG and IgM were positively correlated with TBIL （P〈0 .05） , and both C3 and C4 were negatively correlated with TBIL （P〈0 .05） .IgG ,IgM ,IgA ,and CD4＋ were negatively correlated with PTA （P〈0 .05） ,while CD8＋ ,NK ,C3 ,and C4 were all positively correlated with PTA （P〈0 .05） .Conclusion The immune in‐dexes （IgM ,IgG ,IgA ,CD4＋ ,CD8＋ and NK） are correlated with the complement （C3 and C4） levels in the patients with PBC and autoimmune disease and the combined detection of immune indexes ,complement and their correlation analysis with TBIL and PTA provide important clinical value in assessment and diagnosis of patients .