抗可溶性肝抗原/肝胰抗原抗体在自身免疫性肝炎诊断及分型中的意义

目的探讨抗可溶性肝抗原/肝胰抗原抗体（抗-SLA/LP）在AIH诊断及分型中的意义。方法对6000例采用间接免疫荧光法及免疫印迹法进行自身抗体检测的肝功能异常患者进行回顾性分析。结果6000例肝功异常患者中AIH患者84例,抗-SLA/LP阳性患者18例,占肝功能异常患者的0．3%。在18例抗-SLA/LP阳性患者中17例诊断为AIH,其中2例为AIH重叠原发性胆汁性肝硬化,1例诊断为慢性乙型肝炎。84例中AIH-Ⅰ型65例,AIH-Ⅱ型2例,AIH-Ⅲ型17例。抗-SLA/LP诊断AIH灵敏度为20．2%,特异度为99．7%,诊断AIH的阳性预测值为94．4%。17例AIH-Ⅲ型患者与65例AIH-Ⅰ型患者进行临床资料比较：AIH-Ⅲ型患者ANA滴度低于AIH-Ⅰ组,差异有统计学意义（P＜0．05）;抗-SLA/LP阳性组发病年龄在50岁以上者为58．8% （10/19）,而抗SLA/LP阴性组发病年龄在30～50岁者为52．2%（35/67）。但两组患者在性别构成、发病年龄、肝功能损害程度、凝血酶原活动度、IgG水平、肝硬化发生率及对激素治疗的反应方面的差异均无统计学意义。结论抗-SLA/LP对AIH的诊断有高度特异性。AIH-Ⅲ型患者除发病年龄偏高外,与Ⅰ型患者的临床特点比较,尚未发现差异有统计学意义。

The significance of anti-soluble liver antigen/liver-pancreas in diagnosing and typing autoimmune hepatitis

OBJECTIVE: To study the significance of anti-soluble liver antigen/liver-pancreas (anti-SLA/LP) in diagnosing and typing autoimmune hepatitis (AIH). METHODS: Six thousand patients with abnormal liver functions, who had their autoantibodies checked by immunofluorescent assay (IFA) and immune blotting assay, were reviewed retrospectively. RESULTS: Of these 6000 patients with liver diseases, 84 were diagnosed AIH. Eighteen patients, 0.3% of the 6000, patients with abnormal liver functions, were SLA/LP antibody positive, of which 17 were with AIH-III 2/17 with AIH /primary biliary cirrhosis (PBC) overlap syndrome], and 1 with chronic hepatitis B. Sensitivity and specificity of SLA/LP antibody in diagnosing AIH were 20.2% and 99.7% respectively, and the positive prediction value was 94.44%. The antinuclear antibody (ANA) titer in the AIH-III group was significantly lower than that of the AIH-I group (P < 0.05). The age of patients with anti-SLA/LP was higher (58.8% were over 50 years old) than those without this antibody (52.2% were 30 to 50 years old). There were no significant differences between the type III and type I AIH regarding gender, age, abnormal degree of liver function, PTA, IgG, liver cirrhosis rates and response to immunosuppressive therapy. CONCLUSION: Anti-SLA/LP is highly specific for diagnosing AIH. Comparing the clinical data of type III and type I AIH, we did not find significant differences between the two groups.