抗sp100和抗gp210在原发性胆汁性胆管炎中的诊断和临床意义

Diagnostic value and clinical significance of anti-sp100 and anti-gp210 in patients with primary biliary cholangitis

目的探讨抗sp100和抗gp210对原发性胆汁性胆管炎(PBC)的诊断和临床意义。方法前瞻性的研究2010年8月至2012年5月于首都医科大学附属北京友谊医院肝病中心诊治的90例抗线粒体抗体M2亚型(AMAM2)阳性和(或)组织学符合PBC的患者,收集患者血清标本进行抗gp210和抗sp100检测,并对其中接受熊去氧胆酸[13~15 mg/(kg·d)]治疗的66例患者随访1年以上。观察患者肝脏生化指标变化,并按治疗1年后肝脏生化指标的变化将患者分为生化应答组及无应答组,比较两组抗gp210和抗sp100阳性率的差异。结果抗gp210和抗sp100在90例PBC患者中的阳性率分别为33.3%(30/90)和13.3%(12/90),在AMA-M2阴性患者中的阳性率分别为28.6%(4/14)和1.4%(2/14)。抗gp210阳性组患者与阴性组患者相比,血清白蛋白[分别为(34.9±6.0)、(38.1±4.9)g/L,P=0.009]和胆碱酯酶[分别为(5.4±2.4)、(6.5±2.2)k U/L,P=0.032]降低,丙氨酸氨基转移酶、天冬氨酸氨基转移酶、碱性磷酸酶、谷胺酰转态酶、总胆红素增高,但差异无统计学意义(P>0.05)。抗gp210和抗sp100的阳性率在熊去氧胆酸生化应答组(17.7%,33.3%)和无应答组(9.5%,52.3%)差异无统计学意义(P>0.05)。结论抗gp210阳性可能与PBC患者疾病的严重程度相关。

Objective To discuss the diagnostic value and clinical significant of the gp210 and sp100 antigens in patients with primary biliary cholangitis. Methods This prospective study enrolled 90 PBC patients who was treated at Beijing Friendship Hospital,Capital Medical University between August 2010 to May 2012. Anti-gp210,Anti-sp100 were measured in the sera of 90 patients who were either positive for AMA-M2（ Euroimmun） and/or histologically proven PBC. 66 patients were followed up more than one year to observe the response of ursodeoxycholic acid [13 - 15 mg/（ kg·d） ] treatment. Liver biochemistry were observed during follow-up. All patients were divided into two group according to biochemical response after one year UDCA therapy. The positive rate of Anti-gp210 and Anti-sp100 were compared between two groups. Results Anti-gp210 and Anti-sp100 were positive in 33. 3%（ 30/90） and 13. 3%（ 12/90） of PBC patients,respectively. Compared with gp210-negative patients,gp210-postive patients had lower serum albumin [（ 34. 9 ± 6. 0） g/L vs.（ 38. 1 ± 4. 9） g/L,P = 0. 009]and cholinesterase activity [（ 5. 4 ± 2. 4） kU/L vs.（ 6. 5 ± 2. 2） kU/L,P = 0. 032]. The prevalence of anti-gp210 and anti-sp100 were similar in UDCA biochemical responders（ n = 45） and nonresponders（ n = 21）. Conclusion Anti-gp210 may be a biomarker of disease severity in PBC.