ANA阳性的AIH-PBC重叠综合征与单纯AIH患者抗体特征比较及激素应答影响因素分析

Comparison of antibody characteristics and hormone response in ANA-positive AIH-PBC overlap syndrome and patients with AIH alone Analysis of influencing factors

目的探讨抗核抗体(ANA)阳性的自身免疫性肝炎(AIH)-原发性胆汁性胆管炎(PBS)重叠综合征(OS)与单纯AIH患者的自身抗体特征及6个月内激素应答情况差异。方法回顾分析2018年1月-2021年12月于兰州大学第一医院经肝脏活组织病理检查确诊、糖皮质激素治疗及ANA阳性的自身免疫性肝病患者。将患者分为AIH-PBC OS及单纯AIH两组。收集各组患者确诊时的临床特征、肝穿刺相关指标及自身抗体、使用激素时初始及治疗6个月(包括治疗1、3及6个月时)复查的生化和免疫球蛋白结果,分析自身抗体特点及6个月内激素应答情况差异。结果纳入66例符合标准的研究对象,其中AIH-PBC OS患者44例,单纯AIH患者22例。AIH-PBC OS患者中ANA的核型以胞浆颗粒型为主,占65.9%(29/44),ANA的抗体滴度以1∶320为主,占54.5%(24/44),均高于单纯AIH组患者(P<0.05)。两组患者6个月时激素应答良好率均为59.1%,差异无统计学意义(P>0.05)。AIH-PBC OS患者组内分析结果提示,基线谷丙转氨酶、免疫球蛋白M、碱性磷酸酶及谷氨酰转肽酶为激素应答的影响因素。多因素分析结果中,基线碱性磷酸酶(OR=1.009,95%CI:[1.003,1.016],P<0.05)为独立影响因素,而基线指标对单纯AIH患者激素应答结果的影响差异无统计学意义(P>0.05)。结论ANA阳性的AIH-PBC OS与单纯AIH患者6个月内激素应答效果相似,碱性磷酸酶水平可能是AIH-PBC OS患者6个月内激素应答的影响因素。

Objective To investigate the differences in autoantibody characteristics and hormone response within 6 months between autoimmune hepatitis(AIH)-primary biliary cholangitis(PBS)overlap syndrome(OS)and AIH-only patients all with positivity for antinuclear antibody(ANA).Methods We retrospectively analyzed patients with autoimmune liver disease who tested positive for ANA and underwent liver biopsy from January 2018 to December 2021 at the First Hospital of Lanzhou University.All patients were treated with glucocorticoids.Patients were divided into two groups:AIH-PBC OS and AIH-only.Clinical characteristics,liver biopsy-related indexes,and autoantibodies of patients in each group at the time of diagnosis were collected.Additionally,the biochemistry and immunoglobulins were also collected at the time of diagnosis and initial hormone use,as well as at 1 month,3 months,and 6 months of hormone treatment.Finally,we contrasted antibody profiles and hormonal responses within 6 months between AIH-PBC OS and AIH-only patients with positivity for ANA.Results Overall,66 patients were included.There were 44 AIH-PBC OS patients and 22 AIH-only patients.Among ANA-positive AIH-PBC OS patients,65.9%(29/44)exhibited a cytoplasmic ANA pattern,and 54.5%(24/44)had an ANA titer of 1:320.Both these rates were higher than those among AIH-only patients(P<0.05).The good rate of 6-month hormone response in both groups was 59.1%,and the difference was not statistically significant(P>0.05).Intra-group analysis results showed that baseline glutamic-pyruvic transaminase,immunoglobulin M,alkaline phosphatase and g-glutamyl transferase were the influencing factors of hormone response in AIH-PBC OS patients.In multivariate analysis,alkaline phosphatase was an independent influencing factor(OR=1.009,95%CI:[1.003,1.016],P<0.05).There was no statistical difference in the effect of baseline indicators on the results of hormone response in AIH-only patients(P>0.05).Conclusions At 6 months,ANA-positive AIH-PBC OS would have a similar effect hormone response as AIH-only patients.However,alkaline phosphatase levels may influence 6-month hormone response in AIH-PBC OS patients.