加强对药物性肝损伤中自身抗体滴度的认识

Clinical significance of serum anti-nuclear antibody level in patients with drug-induced liver injury

目的探讨药物性肝损伤（drug-induced liver injury,DILI）患者血清中抗核抗体（anti-nuclear antibody,ANA）的临床特点,总结临床经验,以期望为临床工作提供一定的帮助.方法收集并回顾性分析郑州大学第一附院2012-09/2015-09经肝穿刺确诊的DILI患者44例;根据ANA阳性与否及其滴度的高低水平分组,比较各组的年龄、临床表现、实验室指标[谷丙转氨酶（alanine transaminase,ALT）、谷草转氨酶（aspartate transaminase,AST）、γ-谷氨酰转肽酶（gamma-glutamyl transpeptidase,GGT）、碱性磷酸酶（alkaline phosphatase,ALP）、球蛋白（globulin,GLB）]、病理学表现及保肝治疗效果.呈正态分布的定量资料采用单因素方差分析,非正态分布的定量资料采用Wilcoxon秩和检验,计数资料组间比较采用χ^2检验.结果44例DILI患者中,ANA阴性者17例,ANA低滴度（1：100）16例,ANA中滴度（1：320）11例,其中一般情况（临床表现、年龄）、肝脏生化学指标（ALT、AST、GGT、ALP）差.异方面均无统计学意义（P〉0.05）,而GLB、IgG、肝脏组织病理学、2wk临床保肝治疗肝脏生化指标恢复情况方面表现为统计学差异（P〈0.05）.结论随着血清中ANA滴度的增高,DILI患者肝脏中自身免疫现象更加突出,肝穿刺病理学检验在诊断与评估病情中至关重要.

AIM To analyze the clinical characteristics of serum anti-nuclear antibody（ANA） in patients with drug-induced liver injury（DILI）.METHODS This analysis was performed on the clinical data of 44 patients who were admitted to the First Affiliated Hospital of Zhengzhou University from 2012 to 2015 and diagnosed with DILI by liver puncture.The participants were divided into a low-titer ANA group,a high-titer ANA group,and an ANA-negative group.Comparisons were made for laboratory parameters such as alanine transaminase（ALT）,aspartate transaminase（AST）,alkaline phosphatase（ALP）,gammaglutamyl transpeptidase（GGT）,globulin（GLB）,and immunoglobulin G（IgG）,age,clinical features and pathological characteristics,and therapeutic effects.Comparisons of normally distributed continuous data between groups were performed by one-way analysis of variance,comparisons of non-normally distributed continuous data between groups were made by rank-sum test,and comparisons of categorical data between groups were performed by chisquare test.RESULTS Among the 44 patients,16 had low-titer ANA,11 had high-titer ANA,and 17 were negative for ANA.There were no significant differences in ALT,AST,ALP,GGT,age or clinical features between the three groups（P〉 0.05）.GLB,IgG,pathological characteristics,and therapeutic effects differed significantly between the three groups（P〈 0.05）.CONCLUSION As serum ANA titer increases,liver autoimmune phenomenon becomes prominent in patients with DILI.Liver biopsy pathology is of great significance for the diagnosis and disease evaluation.