多种自身抗体联合检测在原发性胆汁性肝硬化中的诊断价值

目的探讨3种自身抗体(抗-线粒体M2亚型、抗-gp210、抗-Sp100)的联合检测在原发性胆汁性肝硬化中的诊断价值。方法选择2000例隐匿性肝炎患者,根据疾病诊断分为原发性胆汁性肝硬化(PBC)组129例(6.45%)、自身免疫性肝炎(AIH)组205例(10.25%)、AIH-PBC重叠综合征组15例(0.75%)、脂肪肝组514例(25.70%)、药物性肝炎组379例(18.96%)、其他不明原因肝炎组758例(37.90%)。选择同期健康者15例作为对照组。采用ELISA法检测2000例隐匿性肝炎患者血清中抗-线粒体M2亚型(AMA-M2)、抗-核包膜蛋白gp210(anti-gp210)、抗-可溶性酸性磷酸化核蛋白Sp100(anti-Sp100),结合自身免疫性肝病、脂肪性肝病、药物性肝病等疾病的诊断标准进行筛查分析。结果 PBC组AMA-M2、抗-gp210、抗-Sp100阳性率分别为97.67%(126/129)、41.86%(54/129)、27.91%(36/129),抗-gp210、抗-Sp100两者同时出现的阳性率为9.30%(12/129)。12例抗-gp210和抗Sp100抗体阳性的不明原因肝炎患者经肝组织活检后有3例诊断为PBC。PBC组有62.80%(81/129)的AMA-M2抗体滴度水平在1︰800以上,有13.95%(18/129)的AMA-M2抗体滴度水平为1︰25～100,有9.30%(12/129)的AMA-M2抗体滴度水平为1︰100～200。结论 MA-M2阳性仍是诊断PBC的主要诊断指标,AMA-M2、抗-gp210、抗-Sp100的联合检测对PBC的诊断具有较高的应用价值,对筛查其他自身免疫肝病有较好的辅助作用。

Diagnostic value of a variety of autoantibodies detection in patients with primary biliary cirrhosis

Objective To evaluate subtype, anti-gp210, anti-Sp 100 （PBC）. Methods Serum samples by immunoblotting assay in 2000 the diagnostic value of anti-mitochondrial antibodies-M2 by detecting in patients with primary biliary cirrhosis were detected for AMA-M2, anti-gp210 and anti-Sp 100 patients with cryptogenic hepatitis, and other 15 healthy individuals were taken as control group. Patients were diagnosed as PBC （129 cases, 6.45%）, AIH （205 cases, 10.25%）, AIH-PBC overlap syndrome （15 cases, 0.75%）, fatty liver （514 cases, 25.70%）, drug-induced hepatitis （379 cases, 18.96%）, and other unexplained hepatitis （758 cases, 37.90%）. Results The positive rates of these three antibodies were 97.67% （126/129）, 41.86% （54/129）, 27.91% （36/129）, respectively. The simultaneous occurrence rate of anti-gp210 and anti-Spl00 was 9.30% （12/129）.There were 12 cases with positive anti- gp210 and anti-Spl00 antibody, 3 of whom were diagnosed as PBC through liver puncture. In PBC group, patients with AMA-M2 antibody titer high than 1 ： 800 accounted for 62.80% （81/129）, while the percents of patients with titers ranged from 1 ： 25 to 1 ： 100 and from 1 ： 100 to 1 ： 200 were 13.95% （18/129） and 30% （12/129）, respectively. Conclusions AMA- M2 antibody is still the main marker for PBC diagnosis. The combined detection of AMA-M2 antibody, anti-gp210, anti-Spl00 in PBC have a higher value and play a good supporting role in screening other autoimmune liver diseases.