血清抗线粒体抗体亚型对原发性胆汁性肝硬化诊疗的临床评估

目的探讨原发性胆汁性肝硬化（PBC）的临床特点及血清抗线粒体抗体（AMA）亚型M2、M4、M9的诊断价值。方法24例确诊为PBC及127例非PBC患者，系2002年9月至2007年12月拟诊为病毒性肝炎、肝硬化和非PBC肝胆病就诊于门诊及住院者。24例PBC患者应用酶联免疫斑点法检测血清中M2、M4、M9或肝活检证实诊断，非PBC肝胆病者也均检测血清中M2、M4、M9或肝活检排除PBC诊断。15例PBC患者接受正规熊去氧胆酸治疗，服用12个月以上。结果24例PBC患者中22例M2首次检测阳性（91．67％），2例阴性，此2例分别于24周及1周后第二次检测为阳性及弱阳性。4例M4抗体阳性或弱阳性，M9均阴性。127例非PBC肝胆病患者M2、M4、M9均阴性。经熊去氧胆酸治疗的PBC病例黄疸明显减轻，临床症状缓解，未见明显不良反应。全部病例随访中1例死亡。结论PBC在国内并非罕见，M2检测可作为临床诊断PBC的特异性指标，熊去氧胆酸为首选有效的治疗药物。

Clinical features and diagnostic value of anti-mitochondrial antibody subtype in primary biliary cirrhosis

Objective To study the clinical features and diagnostic value of anti-mitochondrial antibody subtype （AMA-M2, M4 and M9） in primary biliary cirrhosis （PBC）. Methods Patients of 24 PBC had been proved through enzyme immune blot assay were used for the detection of AMA-M2, M4 and M9 antibodies in inpatients between 2002 to 2007. Results There were 20 female and 4 male, the average age were 51.5 ± 7.7 years at onset of symptoms, and were 52. 8 ± 8.3 years at diagnosis. The common complaints at onset were when advanced,dark jaundice and hepatosplenomegaly. All the 24 PBC patients diagnosed by clinical presentation were found to be M2 antibody positive ,4 cases M4 were positive or mild positive and M9 were all negative. The 127 patients with other hepato-biliary diseases were all of negative in AMA-M2, M4 and M9 antibodies. The clinical staging was Ⅰ in 3 cases, Ⅱ in 4 cases, m in 9 cases and IVin 8 cases. Associated diseases were major cholelithiasis （ 5 cases,20. 8% ）. Nine patients treated with ursodeoxycholie acid （UDCA） more than 12 months,clinical and biochemical remission occurred in all of cases. Patients were followed up for more than 1 years, 1 patient died due to liver failure, the other 23 were still alive. Conclusions PBC may not be a rare liver disease in China. AMA-M2 antibody detection is an important and sensitive seroimmunological marker for the diagnosis of PBC. The UDCA shows improvement of liver biochemistry and clinical symptoms.