自身抗体和免疫球蛋白检测对鉴别诊断原发性胆汁性肝硬化的价值

目的探讨抗线粒体抗体-M2亚型(AMA-M2)、抗核抗体(ANA)以及免疫球蛋白IgG、IgA、IgM对鉴别诊断原发性胆汁性肝硬化(PBC)与肝脏疾病、自身免疫性疾病的价值及临床意义。方法用酶联免疫法、免疫印迹法以及散色比浊法分别对12例PBC患者、27例病毒性肝炎患者、21例自身免疫性肝病患者、33例SLE患者、34例RF患者、26例SS患者和20例健康体检者同时检测抗AMA-M2抗体、ANA以及免疫球蛋白IgG、IgA、IgM。结果 PBC组阳性率与各组均有显著差异(P<0.01),PBC组阳性率与病毒性肝炎、AIH有显著差异(P<0.01)。体液免疫方面,PBC患者的IgG水平明显高于SLE、RF组(P<0.05,P<0.01),与病毒性肝炎、自身免疫性肝病无统计学意义;IgA水平与其它各组均无显著差异,IgM水平均显著高于其它各组(P<0.01)。结论抗AMA-M2抗体对诊断PBC具有较高的特异性和灵敏度,通过抗AMA-M2抗体、ANA检测对鉴别PBC与病毒性肝炎、AIH有较高的临床诊断价值;通过免疫球蛋白的检测,对鉴别PBC与SLE、RF、SS等自身免疫性疾病有较高的临床诊断价值。

Value of Detecting Antinuclear Antibodies and Immunoglobulin in the Diagnosis of PBC

Objeelive To study the clinical diagnosis value and the clinical significance of anti-mitochondrial antibody（AMA-M2）,antinuelear antibody（ANA）and immunoglobulin （IgG,IgM,IgA）in patients with Primary Biliary Cirrhosis （PBC） and hepar lesion or autoimmune diseases.Methods The sertma levels ofAMA M2,ANA and IgG,IgM,IgA were separately determined by ELISA,Westem blot and scattering immunoturbidimelric assay in 12 patients with PBC,27 ones with viral hepatitis,21 ones with AIH,33 ones with SLE,34 ones with RF,26 ones with SS and 20 cases of nomal conlrols. Results The positive rate of PBC group was significantly higher than that in other groups （P〈0.01）.In humoral immunity, the serum level of IgG in patients with PBC was significantly higher than ones with SLE and RF, but it was no statistical significance comparing with viral hepatitis and AIH.Comparing with other groups,the serum level oflgA in patients with PBC was no statistical significance but IgM was significantly higher.Conclusion The results indicate that the measurement of AMA M2 is highly specific and sensitive in diagnosis PBC.It is useful for differentiation of PBC and viral hepatitis,AIH by detecting AMA M2 and AN＆and also for differentiation of PBC and SLE,RF, SS by detecting levels ofimmunoglobulin.