不同临床类型肝病患者血清中自身抗体的检测及临床应用

目的：分析不同临床类型肝病患者血清中各种自身抗体的存在状况，探讨其临床应用价值。方法采用间接免疫荧光法和免疫印迹法，对我院2010年6月至2014年2月3124例不同类型肝病患者和200例正常健康体检者血清中的抗核抗体(ANA)、抗线粒体抗体(AMA)、抗平滑肌抗体(ASMA)、抗肝肾微粒体抗体(LKM)和自身免疫肝病谱等9项指标进行检测。结果病毒性肝炎ANA、AMA阳性率分别为11.11%、0.39%，抗肝抗原自身抗体检测阳性率分别为AMA M22.22%，M2-3E 1.86%、Sp1000.59%、PML 0.42%、gp2103.81%、LKM-10.62%、LC-12.28%、SLA-LP 0.26%、Ro5210.6%。自身免疫性肝病ANA、AMA阳性率分别为90.63%、78.13%,抗肝抗原自身抗体检测阳性率分别依次为71.87%，71.87%、6.25%、6.25%、65.63%、3.13%、0、21.88%、93.75%。与病毒性肝炎比较，自身免疫肝病的9项指标以及ANA、AMA的差异有统计学意义(P<0.01)。与正常对照组比较，丙肝、自身免疫肝病、药物性肝炎的ANA阳性率的差异有显著统计学意义(P<0.01)。甲肝、戊肝、脂肪肝血清中未检测出自身抗体。与病毒性肝炎比较，药物性肝炎的ANA检出率差异有显著统计学意义(P<0.01)。各型肝炎患者ANA的荧光模型存在差异。结论检测自身抗体的类型、滴度以及荧光模型对于不同类型肝病的诊断和治疗具有临床参考价值。

Detection and clinical application of autoantibodies in serum of patients with different type of hepatopathy

Objective To investigate a series of autoantibodies expression in the serum of patients with differ-ent clinical types of hepatopathy, and their role in diagnosis and clinical application. Methods Retrospective analysis was performed in 3 124 patients with different clinical types of hepatopathy and 200 healthy people undergoing health check, who admitted to our hospital from June 2010 to February 2014, to detect antinuclear antibody (ANA), antimito-chondrial antibody (AMA), antismooth muscle antibody (ASMA), antiliver-kidney microsomes antibody (LKM), antiliv-er specific lipoprotein antibody (ALSP) and 9 indexes of antibody in autoimmune liver disease through indirect immuno-fluorescence and immunoblotting test. Results The positive rates of ANA and AMA of viral hepatitis were respectively 11.11% and 0.39%. Meanwhile, the positive rates of AMA M2, M2-3E, SP100, PML, gp210, LKM-1, LC-1, SLA-LP and Ro50 were respectively 2.22%, 1.86%, 0.59%, 0.42%, 3.81%, 0.62%, 2.28%, 0.26%and 10.6%. The positive rates of ANA and AMA of autoimmune liver disease were 90.63%and 78.13%, respectively. And then, the positive rates of AMA M2, M2-3E, SP100, PML, gp210, LKM-1, LC-1, SLA-LP and Ro50 were 71.87%, 71.87%, 6.25%, 6.25%, 65.63%, 3.13%, 0, 21.88%and 93.75%. The positive rates of ANA, AMA, and 9 indexes of antibody in autoimmune liv-er disease were significantly higher than that of viral hepatitis (P<0.01). There were significant differences between pa-tients with different clinical type of hepatopathy and healthy people in the positive rate of ANA in Hepatitis C, autoim-mune liver disease, and drug-induced hepatitis (P<0.01). All the autoantibodies were not detected in Hepatitis A, Hepati-tis E, and Fatty liver. The positive rate of ANA in drug-induced hepatitis was significantly higher than that of viral hepati-tis (P<0.01). The fluorescence model of ANA was different among all types of hepatopathy. Conclusion The detection of type, titer, and fluorescence model of autoantibodies in different type of hepatopathy is valuable for improving the di-agnosis and therapy.