原发性胆汁性胆管炎自身抗体定性和定量分析的比较及其临床意义

Comparison and clinical significance of qualitative and quantitative analysis of autoantibodies in primary biliary cholangitis

目的以定性和定量方法检测原发性胆汁性胆管炎(PBC)患者自身抗体,比较方法学间的差异及其临床意义。方法选择2016年8月—2018年7月在常熟市第二人民医院、太仓市第一人民医院和张家港市第一人民医院就诊的PBC患者74例。分别以多重微珠流式免疫荧光法、免疫印迹法和间接免疫荧光法检测抗线粒体抗体和抗核抗体,分析各自身抗体在PBC中的分布、不同方法学间的符合度及其与肝功能各指标间的关系。结果所有PBC患者均为抗线粒体抗体M2阳性,抗核抗体中anti-gp210和anti-SP100阳性率分别为22.9%、20.3%;微珠流式免疫荧光法和免疫印迹法检测结果中除抗RNP、Scl-70和Centromere B(Cent B)抗体之外其他自身抗体的符合率均超过90%,其中AMA-M2和抗Sm抗体的两种方法检测结果符合率为100%; AMA-M2定量结果与肝功能各指标间相关性无统计学意义(P>0.05); anti-gp210阳性组患者AMA-M2浓度、碱性磷酸酶(ALP)和总胆红素(T-Bil)较阴性组显著升高(P<0.05); anti-SP100阳性组患者SSA 60、SSB、RNP、Rib P、ds DNA、Histone、PCNA和Cent B抗体表达水平较阴性组显著升高(P<0.05)。结论 PBC患者自身抗体定量和定性检测结果间具有良好的相关性,AMA-M2定量检测结果与anti-gp210的关系提示其可能与患者病情严重程度和临床预后有关。

Objective To investigate the difference and clinical significance of qualitative and quantitative analysis of autoantibodies in primary biliary cholangitis（ PBC）.Methods A total of 74 patients with PBC from Changshu Second People＇s Hospital,Taicang First People＇s Hospital and Zhangjiagang First People＇s Hospital during August 2016 and July 2018 were recruited. Their anti-mitochondrial and antinuclear antibodies were detected by the multiplexed bead-based flow immunofluorescence assay,immunoblotting assay and indirect immunofluorescence assay,respectively. The distribution of different antibodies in PBC,coincidence of different assays and correlations of antibodies with liver function markers were analyzed. Results The anti-mitochondrial antibody M2 type（ AMA-M2） was found in all PBC patients,and the positive rates of anti-gp210 antibody and anti-SP100 antibody were 22.9% and 20.3%,respectively.The coincidence rates of immunoblotting and the multiplexed bead-based flow immunofluorescence assay results were more than 90%except anti-RNP,anti-Scl-70 and anti-Centromere B（ Cent B） antibodies,and those of AMA-M2 and anti-Sm antibodies were 100%.There was no any correlation between AMA-M2 and liver function markers（ P〉0.05）. The levels of serum AMA-M2,alkaline phosphatase（ ALP） and total bilirubin（ T-Bil） in PBC patients with positive anti-gp210 antibody were significantly higher than those with negative anti-gp210 antibody（ P〈0. 05）. The levels of anti-SSA 60,anti-SSB,anti-RNP,anti-RibP,anti-dsDNA,anti-Histone,antiPCNA and anti-Cent B antibodies in PBC patients with positive anti-SP100 antibody were significantly higher than those with negative anti-SP100 antibody（ P〈0.05）. Conclusion There are good correlations between qualitative and quantitative results of autoantibodies in PBC patients,and the correlation between AMA-M2 and anti-gp210 antibody indicates that serum AMA-M2 may be related to the severity and prognosis of PBC.