自身免疫性肝病患者抗体谱检测的临床价值

Clinical value of implementing antibody profile detection in patients with autoimmune liver disease

目的探讨对自身免疫性肝病患者实施抗体谱检测的临床价值。方法选择2016年1月—2019年6月肇庆市第一人民医院收治的30例原发性胆汁肝硬化(PBC)患者作为PBC组,25例自身免疫性肝炎(AIH)患者作为AIH组,另外选择25名健康体检者作为对照组。采用免疫印迹法(WB)对所有研究对象进行血清检测,分析并比较相关抗体〔包括抗线粒体(AMA)-M2抗体、抗2-酮酸脱氢酶复合物(M2-3E)抗体、抗早幼粒细胞性白血病(PML)抗体、抗肝肾微小粒体-1型(LKM-1)抗体、抗可溶性肝抗原/肝胰抗原(SLA/LP)抗体、抗SP100抗体、抗gp210抗体、抗肝特异性细胞质-1型(LC-1)抗体、抗Ro-52抗体〕水平。结果①对照组血清相关抗体阳性率均为0%。②PBC组抗AMA-M2抗体、抗M2-3E抗体、抗PML抗体、抗gp210抗体的阳性率均明显高于AIH组〔抗AMA-M2抗体:90.0%(27/30)比16.0%(4/25),抗M2-3E抗体:80.0%(24/30)比16.0%(4/25),抗PML抗体:56.7%(17/30)比12.0%(3/25),抗gp210抗体:50.0%(15/30)比8.0%(2/25),均P<0.05〕,PBC组抗SP100抗体、抗LC-1抗体阳性率均略高于AIH组,抗SLA/LP抗体、抗Ro-52抗体阳性率均略低于AIH组,但差异均无统计学意义。③PBC组未检测到抗LKM-1抗体,而AIH组抗LKM-1抗体的阳性率为16.0%,差异有统计学意义(P<0.05)。④抗AMA-M2抗体、抗M2-3E抗体、抗PML抗体、抗gp210抗体对PBC诊断的敏感度分别为90.0%、80.0%、56.7%、50.0%,特异度分别为100%、100%、100%、100%。结论采用抗体谱检测可在PBC诊断中获得较理想的效果,但对AIH的诊断则无明显帮助;抗LKM-1抗体对AIH诊断有较高的应用价值,而对PBC诊断则无明显意义。抗体联合检测用于自身免疫性肝病患者的筛查与诊断效果理想,可推广应用。

Objective To explore the clinical value of implementing antibody profile detection in patients with autoimmune liver disease.Methods The 30 patients with primary biliary cirrhosis(PBC)admitted to Zhaoqing First People’s Hospital during January 2016 to June 2019 were selected as PBC group,25 patients with autoimmune hepatitis(AIH)were selected as AIH group,and other 25 healthy examiners were selected as control group.Western blotting(WB)was used to examine the serum of all subjects,and the levels of relevant antibodies[including anti-mitochondrial(AMA)-M2,anti-2-ketovate dehydrogenase complex(M2-3E),anti-promyelocytic leukemia(PML),anti-kidney-1(LKM-1),anti-soluble liver antigen/hepatopancreatic antigen(SLA/LP),anti-SP100,anti-gp210,anti-liver-specific cytoplasmic-1(LC-1)and anti-Ro-52 antibodies]were analyzed and compared.Results①The positivive rate of serum-related antibody in all the control subjects was 0%.②In PBC group,the positive rates of anti-AMA-M2 antibody,anti-M2-3E antibody,anti-PML antibody and anti-gp210 antibody were significantly higher than those in AIH group[anti-AMA-M2 antibody:90.0%(27/30)vs.16.0%(4/25),anti-M2-3Eantibody:80.0%(24/30)vs.16.0%(4/25),anti-PML antibody:56.7%(17/30)vs.12.0%(3/25),anti-gp210 antibody:50.0%(15/30)vs.8.0%(2/25),all P<0.05].In PBC group,all patients had slightly higher positive rates ofanti-SP100 antibody and anti-LC-1 antibody than those in AIH group,and the positive rates of anti-SLA/LP antibody and anti-Ro-52 antibody were slightly lower than those in AIH group,without significant differences.③Noanti-LKM-1 antibody was detected in the PBC group,while the positive rate of anti-LKM-1 antibody in AIH group was 16.0%,with significant difference(P<0.05).④The sensitivities of anti-AMA-M2 antibody,anti-M2-3E antibody,anti-PML antibody,and anti-gp210 antibody for PBC diagnosis were 90.0%,80.0%,56.7%and 50.0%,and the specificities were 100%,100%,100% and 100%,respectively.Conclusions The detection of antibody spectrum could obtain ideal results for the diagnosis of PBC,but it has no obvious significance for the diagnosis of AIH,anti-LKM-1 antibody has high application value in the diagnosis of AIH,but has no significant significance in the diagnosis of PBC.The combined antibody detection has ideal effect in screening and diagnosis of patients with autoimmune liver disease,and can be popularized.