肝功能异常患者中自身抗体及自身免疫性肝病的检测

目的 自身免疫性肝病临床流行病学调查,观察在肝功能异常患者中自身抗体检测的阳性率、自身免疫性肝病检出率及临床意义。方法 连续收集就诊病例中肝功能异常患者丙氨酸氨基转移酶(ALT)大于40 U/L血清511份,分别进行相关自身抗体(ANA)检测,并查阅临床资料。结果 511份血清检测出ANA阳性率为14.09％,抗平滑肌抗体(SMA)阳性率0,59％,抗线粒体抗体(AMA)阳性率2.94％,抗线粒体抗体亚型-丙酮酸脱氢酶复合物(AMA-M2)阳性率0.98％;ANA谱中的SS-A阳性率0.59％、SS-B阳性率0.20％、JO-1阳性率0.20％,dsDNA阳性率0.78％;未检出抗肝肾微粒体抗体(LKM-1)、可溶性肝抗原/肝胰抗原(SLA/LP)、抗肝细胞溶质抗原1型抗体(LC-1)及ANA谱中其他抗体。从ALT升高的患者中收集到的511份血清,可查到完整临床资料者共469例。原发性胆汁性肝硬化(PBC)及自身免疫性肝炎(AIH)患者检出率分别为1.06％及0.43％,未检出原发性硬化性胆管炎患者。自身抗体阳性患者77.78％诊断为病毒性肝炎及相关疾病。病毒性肝炎及相关疾病中自身抗体阳性率为18.29％。结论 高滴度(>1:320)自身抗体对自身免疫性肝病诊断有意义。PBC及AIH患者检出率近似丙型及戊型肝炎检出率,临床不能忽视,病毒性肝炎及相关疾病中可检测出自身抗体。

The positive rate of auto antibodies and autoimmune liver diseases in patients with abnormal liver function

Objective To investigate the positive rate of auto antibodies and autoimmune liver diseases in patients with abnormal liver function and it's clinical significance. Methods 511 sera with abnormal ALT (>40 U/L) were continuously collected, all the sera were examined for antibodies and clinical information of 469 cases were studied. Results Among the 511 sera, 14.09% of them showed of ANA positive, 0.59% of SMA positive, 2.94% of AMA positive, 0.98% of AMA-M2 positive, 0.59% of SS-A positive, 0.19% of SS-B positive, 0.19% of JO-1 and 0. 78% of dsDNA positive and all SLA/LP, LC-1 and LKM-1 and ANA profile were negative. Clinical information was analyzed on 469 cases which have complete data from the 511 patients. of these 469 cases, 5 cases (1.06%) were found to be PBC, 2 case (0.43%) were AIH, no PSC was found, 77.78% patients among those with positive auto antibodies were diagnosed as viral hepatitis and there were 18.29% patients with viral hepatitis showed different auto antibodies. Conclusion The high titer auto antibodies (>1: 320) were important criterion for diagnosis of autoimmune liver diseases. The positive rate of autoantibodies of autoimmune liver diseases was similar to hepatitis C and E.