Autoimmune liver serology:Current diagnostic and clinical challenges

Liver-related autoantibodies are crucial for the correct diagnosis and classification of autoimmune liver diseas-es(AiLD),namely autoimmune hepatitis types 1 and 2(AIH-1 and 2),primary biliary cirrhosis(PBC),and the sclerosing cholangitis variants in adults and children.AIH-1 is specified by anti-nuclear antibody(ANA) and smooth muscle antibody(SMA).AIH-2 is specified by antibody to liver kidney microsomal antigen type-1(anti-LKM1) and anti-liver cytosol type 1(anti-LC1).SMA,ANA and anti-LKM antibodies can be present in de-novo AIH following liver transplantation.PBC is specified by antimitochondrial antibodies(AMA) react-ing with enzymes of the 2-oxo-acid dehydrogenase complexes(chiefly pyruvate dehydrogenase complex E2 subunit) and disease-specific ANA mainly react-ing with nuclear pore gp210 and nuclear body sp100.Sclerosing cholangitis presents as at least two variants,first the classical primary sclerosing cholangitis(PSC) mostly affecting adult men wherein the only(and non-specific) reactivity is an atypical perinuclear antineutro-phil cytoplasmic antibody(p-ANCA),also termed peri-nuclear anti-neutrophil nuclear antibodies(p-ANNA) and second the childhood disease called autoimmune sclerosing cholangitis(ASC) with serological features resembling those of type 1 AIH.Liver diagnostic serol-ogy is a fast-expanding area of investigation as new purified and recombinant autoantigens,and automatedtechnologies such as ELISAs and bead assays,become available to complement(or even compete with) tradi-tional immunofluorescence procedures.We survey for the first time global trends in quality assurance impact-ing as it does on(1) manufacturers/purveyors of kits and reagents,(2) diagnostic service laboratories that fulfill clinicians' requirements,and(3) the end-user,the physician providing patient care,who must properly interpret test results in the overall clinical context.

Correlation between serum uric acid levels and clinical characteristics in patients with longitudinally extensive transverse myelitis A case-control study

Uric acid is reduced in demyelinating diseases, including multiple sclerosis and neuromyelitis optica （NMO）. Longitudinally extensive transverse myelitis （LETM） is often an early manifestation of NMO. Whether uric acid levels are reduced at presentation of LETM remains unknown. The present study investigated serum uric acid levels by evaluating 35 patients with LETM, 64 with NMO, 62 with multiple sclerosis, 63 with other neurological diseases and 65 healthy controls. In addition, we tested the correlation between serum uric acid and the clinical characteristics of LETM. All patients were in the acute phase, defined as less than 1 month from onset or relapse. The results revealed that serum uric acid levels in LETM were significantly lower than in multiple sclerosis, other neurological diseases and healthy controls, but no difference was found between LETM and NMO. A negative correlation between uric acid levels and Expanded Disability Status Scale scores was found in LETM patients （r = -0.545, P 〈 0.05）. The results suggest that uric acid levels are reduced in patients with LETM, raising the possibility that lower uric acid levels are an indicator of disease disability. Moreover, reduced uric acid levels may be a risk factor in NMO.

The Diagnosis of Diffuse Goitre by Ultrasound Imaging in Children

In order to find an easy and accurate procedure for diagnosis of diffuse goitre in children, we examined 50 patients with diffuse goitre using fine needle aspiration biopsy cytology, thyroid antibody detection, thyroid hormone analysis and ultrasound imaging. In the meantime, 109 healthy children (control) were examined by ultrasound imaging. The results showed that thyroid imaging in health children was a smooth echo pattern with stronger homogenous echogram than surrounding muscle tissues. The patients with diffuse goitre showed an normally enlarged thyroid volume. In 22 (84. 6 %) of 26 children With chronic lymphocytic thyroiditis, a varied patch hypoechogenicity was found, of whom 18 (81. 8 % ) had positive results of antibody testing. On the contrary, echo-pattern was normal in 17 (70. 8 %) of 24 patients with diffuse thyroid proliferation and only the remainder (7/24, 29. 1% ) had abnormal echo-pattern as well as elevated auto-antibody titers, of whom 2 were confirmed as chronic lymphocytic thyroiditis by a repeat fine needle aspiration biopsy 1 year later. By using combined ultrasound imaging and antibody determination, 92 % of the cases with chronic lymphocytic thyroiditis could be diagnosed. Our study suggests that ultrasonic imaging is an easy, non-invasive, reproducible and effective procedure in the differen,tial diagnosis of chronic lymphocytic thyroiditis in children.

Expression of Auto-antiboby in Patients wih Acute Pancreatitis and its Clinical Significance

The expression of an auto-antibody in patients with edematous acute pancreatitis and its possible clinical significance was investiaged. Eighteen cases of acute pancreatitis were chosen as experimental group and 25 subjects served as control group. Venous blood samples were taken in both groups at 4 time points: at the day of admission, the 2nd, 4th and 7th day of hospitalization. By using indirect immuno-fluorescence tests the expression of auto-antibody in the samples was semiquantitatively detected. Other biochemical indexes, such as serum amylase, urine amylase, were determined simultaneously. As well, the clinical signs or symptoms were mornitored. It was found that the expression of the auto-antibody was gradually enhanced with the development of acute pancreatitis. The inceased positive expression of auto-antibody showed a correlationship with the improvement of biochemical indexes (r=0.951) and clinical manifestations (r=0.996). There was significant difference between experimental and control groups (P<0.05). During the recovery period of acute pancreatitis, gradually increased auto-antibody expression was detectable. This antibody is against the interstitial structure of the pancreas.