自身抗体检测在肝病患者中的临床价值分析

Analysis of the clinical value of autoantibodies detection in patients with liver disease

目的探讨自身抗体检测在肝病患者中的临床价值。方法回顾性分析2020年8月至2021年4月于首都医科大学附属北京地坛医院就诊的1495例门诊或住院的肝病患者的病例资料,分别采用间接免疫荧光法、免疫印迹法检测抗核抗体(antinuclear antibody,ANA)、ANAs。结果各种病因肝病患者均可见ANA及ANAs阳性。1495例肝病患者中ANA阳性494例,阳性率33.04%;ANAs阳性573例,阳性率38.33%。免疫性肝病组ANA阳性率(63.37%)高于病毒性、酒精性、脂肪肝、复合病因和其他肝病组,差异具有统计学意义(P<0.01),病毒性、酒精性、脂肪肝、复合病因组之间ANA阳性率两两比较均具有统计学意义(χ^(2)=19.823,P<0.01);免疫性肝病组ANAs阳性率(80.23%)高于其他肝病病因组,差异具有统计学意义(P<0.05)。免疫性肝病组抗体滴度以1∶1000为主,其他肝病病因组以1∶100为主,不同病因肝病组最常见的两种荧光核型均为胞浆型和核颗粒型。免疫性肝病组最常见的特异性抗体是抗AMA-M2抗体,病毒性、药物性、复合病因、其他病因组最常见的是抗Ro-52抗体,酒精性肝病最常见的是抗SSA抗体。免疫性肝病组抗SSA抗体(17.44%)、抗SSB抗体(9.30%)、抗CENP-B抗体(22.09%)、抗Ro-52抗体(41.28%)、抗AMA-M2抗体(51.74%)阳性率高于其他肝病病因组,差异具有统计学意义(P<0.01)。当ANA荧光核型为核颗粒型时,免疫性肝病组抗CENP-B抗体、抗Ro-52抗体、抗AMA-M2抗体阳性率高于病毒性肝病组(P<0.01),抗Ro-52抗体阳性率高于药物性肝病组(P<0.05)。结论自身免疫性肝病ANA滴度以1∶1000为主,ANAs以抗SSA抗体、抗SSB抗体、抗CENP-B抗体、抗Ro-52抗体、抗AMA-M2抗体阳性为主,尤其是抗AMA-M2抗体。联合ANA荧光核型和ANAs进行分析时,如荧光核型为核颗粒型,ANAs中抗Ro-52抗体阳性在鉴别免疫性与病毒性、药物性肝病的价值中更大。

Objective To explore the clinical value of autoantibodies in patients with liver disease.Methods We retrospectively analyzed the data of 1495 outpatients or inpatients with liver disease in Beijing Ditan Hospital of Capital Medical University from August 2020 to April 2021.Indirect immunofluorescence and Western blot were used to detect antinuclear antibody(ANA)and antinuclear antibodies(ANAs).Results ANA and ANAs were positive in patients with liver diseases of various etiologies.Among 1495 patients with liver disease,494 cases were ANA positive,the positive rate was 33.04%;573 cases were positive for ANAs,the positive rate was 38.33%.The positive rate of ANA in the immune liver disease group(63.37%)was higher than that in the viral,alcoholic,fatty liver,confounding factors and other liver disease groups,and the difference was statistically significant(P<0.01).The ANA positive rate between the viral,alcoholic,fatty liver,and confounding factor groups was statistically significant(χ^(2)=19.823,P<0.01),the positive rate of ANAs in the immune liver disease group(80.23%)was higher than that in other liver disease groups,and the difference was statistically significant(P<0.05).The antibody titer of immune liver disease group was mainly 1∶1000,and other liver disease etiology groups was mainly 1∶100.The two most common fluorescent karyotypes in liver disease groups of different etiologies are cytoplasmic and nuclear granular types.The most common specific antibody in the immune liver disease group was anti-mitochondrial antibody type 2(anti-AMA-M2)antibody,the most common anti-Ro-52 antibody in viral,drug-induced,complex etiology,and other etiological groups,and the most common anti-SSA antibody in alcoholic liver disease.Anti-SSA antibody(17.44%),anti-SSB antibody(9.30%),anti-CENP-B antibody(22.09%),anti-Ro-52 antibody(41.28%),anti-AMA-M2 antibody(51.74%)were positive in immune liver disease group,The rate was higher than that of other liver disease etiology groups,and the difference was statistically significant(P<0.01).When the ANA fluorescence karyotype is nuclear granule type,the positive rate of anti-CENP-B antibody,anti-Ro-52 antibody,and anti-AMA-M2 antibody in the immune liver disease group was higher than that in the viral liver disease group(P<0.01),The positive rate of anti-Ro-52 antibody was higher than that of drug-induced liver disease group(P<0.05).Conclusions The ANA titer of autoimmune liver disease was mainly(1∶1000).ANAs were mainly positive for anti-SSA antibody,anti-SSB antibody,anti-CENP-B antibody,anti-Ro-52 antibody,and anti-AMA-M2 antibody,especially anti-AMA-M2 antibody.When combined with ANA fluorescent karyotype and ANAs for analysis,if the fluorescent karyotype is nuclear particle type,the positive anti-Ro-52 antibody in ANAs is more valuable in distinguishing immunity from viral and drug-induced liver diseases.