自身免疫性肝病抗体谱和肝功能检测对自身免疫性肝病与药物性肝损伤的鉴别诊断价值

Differential Diagnosis on Detection of Autoimmune Liver Disease Antibody Spectrum and Liver Function in Autoimmune Liver Disease and Drug-induced Liver Disease

目的探讨自身免疫性肝病(AILD)抗体谱和肝功能检测在AILD与药物性肝损伤(DILI)鉴别诊断中的应用价值。方法选取2016年6月～2018年1月广西医科大学第一附属医院收治的85例AILD患者和70例DILI患者作为研究对象,检测两组患者的AILD相关自身抗体以及肝功能指标。结果 AILD组抗核抗体(ANA)、抗着丝点抗体(ACA)、抗线粒体抗体(AMA)、抗线粒体抗体M2型(AMA-M2)、抗平滑肌抗体(SMA)的阳性率均明显高于DILI组,差异有统计学意义(P<0.05)。AILD组抗肝肾微粒体抗体(LKM)、抗肝细胞溶质抗原抗体(LC-1)及抗胃壁细胞抗体(PCA)阳性率与DILI组比较,差异无统计学意义(P>0.05)。原发性胆汁性肝硬化(PBC)患者的AMA、AMA-M2阳性率明显高于自身免疫性肝炎(AIH)患者(P<0.05)。AILD组与DILI组患者丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、碱性磷酸酶(ALP)、γ-谷氨酰基转移酶(GGT)水平均明显高于其正常值上限,同组患者肝功能结果波动范围较大。结论联合检测ANA、ACA、AMA、AMA-M2对AILD与DILI的鉴别有一定价值,可用于AILD的早期筛查。而两组肝功能检测结果均较正常值升高,对鉴别诊断意义不大。

Objective To investigate the application value of autoimmune liver disease antibody spectrum and liver function detection in autoimmune liver disease (AILD) and drug-induced liver disease (DILI) on differential diagnosis.Methods A total of 85 patients with AILD and 70 patients with DILI admitted to the First Affiliated Hospital of Guangxi Medical University from June 2016 to January 2018 were selected to detect AILD-related autoantibodies and liver function indexes in two groups of patients.Results The positive rates of anti-nuclear antibody (ANA),anti-centromere antibody (ACA),anti-mitochondrial antibody (AMA),anti-mitochondrial antibody M2 (AMA-M2) and anti-smooth muscle antibody (SMA) were significantly higher in AILD group than in DILI group,and the difference were statistically significant ( P <0.05).There was no significant difference in anti-liver-kidney microsomal antibody(LKM),anti-liver cytosol antigen type I antibody(LC-1) and anti-parietal cell antibody (PCA)between the two groups of AILD group and DILI Group ( P >0.05).The positive rates of AMA and AMA-M2 in patients with primary biliary cirrhosis (PBC) were significantly higher than those in patients with autoimmune hepatitis (AIH)( P <0.05).Alanine aminotransferase (ALT),aspartate aminotransferase (AST),alkaline phosphatase (ALP) and gamma-glutamyl transferase (GGT) levels in AILD and DILI groups were significantly higher than the upper limit of normal values.The fluctuation range of liver function was large in the same group of patients.Conclusion Combined detection of ANA,ACA,AMA and AMA-M2 has certain value in distinguishing AILD from DILI,and can be used for early screening of AILD.The results of liver function test in both groups were higher than normal values,which had little significance for differential diagnosis.