自身抗体在自身免疫性肝病中的临床表达分析

An Analysis of Clinical Expressions of Autoantibodies in Autoimmune Liver Disease

目的探讨抗核抗体(ANA)、抗核抗体谱(ANAs)、AILD抗体,在AILD不同亚型患者中的分布特点及临床特征。方法选取2018年1月至2021年12月重庆市中医院住院并确诊的233例AILD患者作为病例组,其中包括原发性胆汁性胆管炎(PBC)患者107例,自身免疫性肝炎(AIH)患者86例,OS患者(PBC合并AIH)40例;另选取同期住院并确诊的药物性肝损伤(DILI)患者173例作为疾病对照组和健康体检者180例作为健康对照组。分析病例组与疾病对照组、健康对照组的ANA、ANAs和AILD抗体差异,以及病例组合并肝外自身免疫性疾病与ANA、ANAs的关系。结果PBC、OS患者ANA抗体滴度以1∶320和1∶1000为主,主要是复合荧光核型,阳性率最高的是着丝点/胞浆型;AIH患者以1∶100和1∶320为主,主要是单一荧光核型,阳性率最高的核颗粒型。PBC、OS患者阳性率最高的是AMA-M2且高于AIH患者(P<0.05),AIH患者阳性率最高的抗Ro-52抗体与PBC、OS患者比较,差异无统计学意义(P>0.05)。PBC、AIH、OS患者检出率最高的分别是抗gp210抗体、SLA/LP、抗sp100抗体,OS患者抗sp100抗体高于PBC、AIH患者(P<0.05);AILD患者合并肝外自身免疫性疾病发病率最高的是干燥综合征(SS);ANA、ANAs阳性的AILD患者合并SS的阳性率高于阴性患者(P<0.05)。结论ANA荧光核型、ANAs、AILD抗体对AILD疾病分型具有重要意义,ANA、ANAs阳性的AILD患者更易合并SS。

Objective To investigate the distribution and clinical characteristics of antinuclear antibodies(ANA), antinuclear antibody profiles(ANAs) and AILD antibodies in patients with different subtypes of AILD.Methods A total of 233 patients with AILD who were hospitalized and diagnosed in Chongqing Traditional Chinese Medicine Hospital from January, 2018 to December, 2021 were selected as the case group, including 107 patients with primary biliary cholangitis(PBC), autoimmune hepatitis(AIH), and 40 patients with OS(PBC combined with AIH), while 173 patients with drug-induced liver injury(DILI) who were hospitalized and diagnosed during the same period were selected as the disease control group and 180 healthy people were selected as the healthy control group. The differences of ANA, ANAs and AILD antibody levels among the disease group and the disease control group and the healthy control group, as well as the relationship between the case group and extrahepatic autoimmune diseases and ANA, ANAs were analyzed.Results The positive rates of ANA, ANAs, and AILD antibodies in the case group were significantly higher than those in the two control groups(P<0.05). Titers of ANA antibody in PBC and OS patients were mainly 1∶320 and 1∶1 000, and were mainly composite fluorescent karyotype, and nuclear granule/cytoplasmic and centromere/cytoplasmic nuclei had the highest positive rate;AIH patients were mainly 1∶100 and 1∶320, and mainly had a single fluorescent karyotype, and the nuclear particle type with the highest positive rate. The highest positive rate of AMA-M2 in PBC and OS patients was higher than that in AIH patients(P<0.05). Anti-Ro-52 antibody with the highest positive rate in AIH patients was not significantly different from that in PBC and OS patients(P>0.05). The highest detection rates in PBC, AIH and OS patients were anti-gp210 antibody, SLA/LP, and anti-sp100 antibody. Anti-sp100 antibody in OS patients was higher than that in PBC and AIH patients(P<0.05);AILD patients complicated with extrahepatic autoimmunity Sjogren’s syndrome(SS) had the most common disease incidence;AILD patients with positive ANA and ANAs had a higher positive rate of SS combined with SS than that of negative patients(P<0.05).Conclusion ANA fluorescent karyotype, ANAs, and AILD antibodies are of great significance for AILD disease classification. AILD patients with positive ANA and ANAs are more likely to have SS.