抗延胡索酸水合酶抗体对自身免疫性肝炎和药物性肝损伤的鉴别诊断价值

Value of fumarate hydratase antibody in differential diagnosis of autoimmune hepatitis and drug-induced liver injury

目的评价抗延胡索酸水合酶抗体(抗-FH)检测用于自身免疫性肝炎(AIH)和药物性肝损伤(DILI)鉴别诊断中的价值。方法选取2014年3月-2016年12月北京佑安医院住院的AIH患者105例为AIH组,DILI患者92例为DILI组,另选128例健康人为对照组,应用ELISA法检测血清中的抗-FH水平。计量资料两组间比较采用t检验或Mann-Whitney U检验,计数资料组间比较采用χ^2检验或Fisher精确概率法。采用Kappa检验对抗-FH的诊断符合程度进行一致性分析。分析抗-FH在AIH诊断中的灵敏度、特异度、阳性预测值和阴性预测值。结果 AIH组患者的ANA阳性率明显高于DILI组(72.4%vs 55.4%,χ^2=6.147,P=0.013),IgG水平也明显高于DILI组[(18.3±6.1) g/L vs (15.2±5.4) g/L,t=-2.566,P=0.011]。在AIH患者中抗-FH的阳性率为36.2%(38/67),显著高于DILI组的6.5%(6/92)和健康对照组的2.3%(3/128)(χ^2=59.959,P <0.001)。抗-FH对AIH诊断的灵敏度为36.2%,特异度为93.5%,阳性预测值86.4%,阴性预测值93.5%。结论血清抗-FH对AIH和DILI的鉴别诊断具有一定的参考价值。

Objective To investigate the value of fumarate hydratase antibody(anti-FH) in the differential diagnosis of autoimmune hepatitis(AIH) and drug-induced liver injury(DILI).Methods From March 2014 to December 2016,105 patients with AIH who were hospitalized in Beijing You’an Hospital were enrolled as AIH group,and 92 patients with DILI were enrolled as DILI group.A total of 128 healthy individuals were enrolled as control group.ELISA was used to measure the serum level of anti-FH.The t-test or the Mann-Whitney U test was used for comparison of continuous data between two groups,and the chi-square test or the Fisher’s exact test was used for comparison of categorical data between groups.A consistency analysis of diagnostic compliance of anti-FH based on the Kappa test.The sensitivity,specificity,positive predictive value,and negative predictive value of anti-FH in the diagnosis of AIH were analyzed.Results Compared with the DILI group,the AIH group had significantly higher positive rate of anti-nuclear antibody(72.4% vs 55.4%,χ^2=6.147,P = 0.013) and level of IgG((18.3 ± 6.1) g/L vs(15.2 ± 5.4) g/L,t =-2.566,P = 0.011)).The AIH group had a significantly higher positive rate of anti-FH than the DILI group and the control group(36.2%(38/67) vs 6.5%(6/92) and 2.3%(3/128),χ^2= 59.959,P < 0.001).In the diagnosis of AIH,anti-FH had a sensitivity of 36.2%,a specificity of 93.5%,a positive predictive value of 86.4%,and a negative predictive value of 93.5%.Conclusion Serum anti-FH has a certain reference value in the differential diagnosis of AIH and DILI.