抗核抗体及抗中性粒细胞胞浆抗体与胆道闭锁严重程度和预后的相关性研究

Correlation antinuclear antibody and antineutrophil cytoplasmic antibody with severity and prognosis in biliary atresia

目的研究胆道闭锁(Biliary atresia,BA)患儿血浆抗核抗体(Antinuclear antibodies,ANA)及抗中性粒细胞胞浆抗体(Antineutrophil cytoplasmic antibody,ANCA)阳性率及其临床意义。方法收集2017年4月至2020年10月行肝移植手术(LT)BA患儿的临床资料并随访LT术后转归,检测其血浆中的ANA(半定量)和ANCA(定性),并分析与术前实验室检查、严重程度、肝脏病理及术后并发症的相关性。计量资料采用秩和检验,计数资料采用χ^(2)检验,相关性分析采用Spearman分析。结果本研究ANA阳性率为3.3%(3/90),且ANA比值随自体肝生存时间延长而降低(R=-0.326),并与Child-Pugh评分(R=0.230)和儿童终末期肝病模型(R=0.257)呈正相关。肝硬化患儿ANA比值显著升高(0.24 vs 0.20,P=0.016),且随细胆管胆栓程度加重而升高(P=0.040)。此外,术后CMV感染者ANA比值显著升高(0.31 vs 0.22,P=0.034)。ANCA阳性率为10.2%(10/98),阳性患儿术前白蛋白(Alb)和胆碱酯酶(CHE)水平显著低于ANCA阴性患儿(Alb:30.4 vs 34.3 g/L,P=0.018;CHE:2.6 vs 3.9 KU/L,P=0.009)。结论BA患儿血浆中ANA及ANCA阳性率较低,但与肝脏合成功能、病理特征、术后感染等具有相关性,提示自身抗体对评估BA严重程度及预后具有一定的临床价值。

Objective To investigate the prevalence rate and clinical significance of plasma antinuclear antibody(ANA)and antineutrophil cytoplasmic antibody(ANCA)in patients with biliary atresia(BA).Methods The clinical and follow-up data of BA patients underwent liver transplantation(LT)from April 2017 to October 2020 were retrospectively collected.The plasma ANA were semi-quantitatively measured and ANCA were qualitatively detected,and the correlation with laboratory parameters,severity,pathological histological features and post-LT complications were analyzed.Rank sum test was used for continuous data and Chi-square test was used for categorical data.Correlations were evaluated by the Spearman’s correlation analysis.Results The prevalence rate of ANA was 3.3%(3/90),and the ANA ratio decreased with the length of native liver survival(R=-0.326).There was a positive correlation between the ANA ratio and Child-Pugh score(R=0.230),as well as score of pediatric model of end-stage liver disease(R=0.257).The ANA ratio was significantly higher in patients with cirrhosis(0.24 vs 0.20,P=0.016)and the ratio increased with higher degree of ductular cholestasis(P=0.040).In addition,the ANA ratio was significantly higher in patients with CMV infection post-LT(0.31 vs 0.22,P=0.034).The ANCA positive rate was 10.2%(10/98).Prior-LT,plasma Albumin(Alb)and cholinesterase(CHE)level in ANCA-positive patients was significantly lower than that in ANCA-negative patients(Alb:30.4 vs 34.3 g/L,P=0.018;CHE:2.6 vs 3.9 KU/L,P=0.009).Conclusion The prevalence rate of ANCA and ANA of patients with BA is low,but it correlates with liver synthetic function,fibrosis stage and post-LT CMV infection.Autoantibodies may be of clinical value for the assessment of BA severity and post-LT prognosis.