慢性肝病中抗肝抗原自身抗体的检测

Detection of autoantibodies to liver antigens in Chinese patients with different liver diseases

目的 探讨中国人不同病因所致慢性肝病患者中抗肝抗原自身抗体的存在状况及自身免疫性肝病的自身抗体特征。方法 166例肝功能异常患者分为 6组 :自身免疫性肝炎 (AIH ) 12例、原发性胆汁性肝硬化 (PBC) 2 0例、原发性硬化性胆管炎 (PSC)13例、HBV组 66例、HCV组 2 2例、肝豆状核变性 (HDL) 3 9例。用间接免疫荧光法检测抗核抗体 (ANA)、平滑肌抗体 (SMA)、抗肝肾微粒抗体I型抗体 (anti LKM1)、抗线粒体抗体 (AMA)和抗中性粒细胞胞浆抗体 (ANCA) ,免疫印迹法检测抗肝细胞胞溶质抗原 1型抗体 (anti_LC1)、抗可溶性肝抗原 /肝胰抗原抗体 (anti_SLA/LP)、抗肝肾微粒抗体 1型 (anti_LKM1)、AMA_M2亚型等多种肝抗原自身抗体。结果 166例中ANA、AMA、M_2、pANCA阳性率在 7组中有显著差异 (P <0 .0 1)。PBC中AMA、M 2阳性检出率均为 10 0 % ,PSC中pANCA阳性检出率为 5 3 8% ,Fisher精确检验在a =0 .0 0 2水准与其他各组比较有显著差异。AIH与PBC的ANA阳性率分别为10 0 %和 60 % ,Fisher精确检验在a =0 .0 0 2水准二者无显著差异。与其他各组比较有显著差异。在AIH组SMA阳性率为 2 5 % ,LKM 1、LC 1、SLA/LP阳性率均为 8.3 % ,统计学处理与其他组无显著差异 (P >0 0 5 ) ,可能与病例少有关。PBC中分别有

Objective To study autoantibodies to liver antigens in Chinese patients with different liver diseases and to discuss the characteristics of autoantibodies in autoimmune liver diseases. Methods 166 patients with abnormal liver function were chosen and divided into 6 groups:(1) autoimmune hepatitis (AIH) group,12 cases;(2)primary biliary cirrhosis (PBC) group,20 cases;(3)primary sclerosing cholangitis (PSC) group,13 cases;(4)chronic hepatitis B(HBV) group,66 cases,(5)chronic hepatitis C(HCV)group,22 cases;(6)hepatolenticular degeneration (HDL) group,39 cases.20 healthy blood donors were control group.Antinuclear antibody (ANA),smooth muscle antibody (SMA),antimitochondrial antibody (AMA),antibody to liver/kidney micrososme type 1(anti-LKM1),perinuclear antineutrophil cytoplasmic antibody (pANCA) and cANCA were tested by indirect immunofluorescence.Then,anti-LKM1,antibody to liver cytosol type 1(anti-LC1),antibody to soluble liver antigen/liver-pancreas (anti-SLA/P) and subtype 2 of AMA (M-2) were detected by Western blot.Results AMA and M-2 positive were found in all PBC,and pANCA positive was found in 53.8% of PSC.ANA positive were found in all AIH and 60% of PBC.But there was no significant difference between them.In AIH group,SMA positive had been detected in 25% of patients.In additional,anti-LKM1 anti-LC1 and anti-SLA/LP were positive in 8.3% of AIH,respectively. Autoimmune overlap syndrome was found in 2 cases (AIH/PBC) with PBC,1 case (PSC/AIH) with PSC and 1 case (PBC/AIH) with AIH.However,few autoantibodies to liver antigens were found in non-autoimmune liver diseases group.Conclusion The detection for autoantibodies to liver antigens,ANA and subtype 2 of AMA are helpful for diagnosis and differential diagnosis for autoimmune live diseases.