自身抗体分析在慢性胆汁淤积性肝病鉴别诊断中的价值

目的分析多种自身抗体在慢性胆汁淤积性肝病鉴别诊断中的价值。方法选取186例慢性胆汁淤积性肝病的患者,包括107例原发性胆汁性肝硬化（PBC）、48例原发性硬化性胆管炎（PSC）、18例AMA阳性的自身免疫性肝炎（AIH）、13例其他肝内胆汁淤积患者,用酶联免疫吸附试验（ELISA）检测这些患者血清中传统的抗AMA-M2、抗AMA-M2-3E（BPO）IgG、抗AMA-M2-3E（BPO）IgA、抗gp210抗体、抗Sp100抗体、抗PML抗体、抗SLA/LP抗体、抗ACA抗体。结果 107例PBC患者抗M2-3E ELISA法AMA-M2 IgG的检出率为86.9%。在AMA-M2 IgG阳性病人中抗gp210和抗Sp100抗体明显高于抗PML抗体、抗SLA/LP抗体、抗ACA抗体差别具有统计学意义（P〈0.05）。27例AMA-M2阴性的PBC患者中有11例患者AMA-M2 IgG阳性,16例患者存在AMA-M2-3E IgG、抗Sp100抗体、抗gp210抗体1种或几种的组合。抗Sp100抗体、抗gp210抗体只在PBC患者和AMA阳性的自免疫性肝炎患者中被检测到,且抗gp210抗体出现在愈后差的患者中。结论 AMA和抗核抗体（ANA）检测在慢性胆汁淤积性肝病鉴别诊断中具有重要作用。

Value of detection of autoantibody in differential diagnosis of chronic cholestatic liver disease

Objectives To evaluate the value of detection of autoantibody in the differential diagnosis of chronic cholestatic liver disease.Methods 186 chronic cholestatic liver disease patients,including 107 primary biliary cirrhosis（PBC）patients,48 primary sclerosing cholangitis（PSC） patients,18 AMA-position autoimmune hepatitis（AIH）patients and 13 other chronic cholestatic liver disease patients were investigated for anti-AMA M2、anti-AMA M2-3E（BPO）、anti-Spl00、anti-gp210、anti-PML、anti-ACA and anti-SLA/LP by ELISA.Results The positive ratio of AMA-M2 IgG in 107 PBC patients was 86.9% using M2-3E ELISA.The gp210 and sp100 antibodies were significantly higher than PML,SLA/LP and ACA antibodies in AMA-M2 IgG positive patients（P0.05）.27 out of 107 PBC patients with were AMA-negative by conventional ELISA.Within these 27 patients,11 were found to be AMA-positive by the IgG Anti-M2-3E ELISA.Moreover,according to the data from 3 tests（Anti-M2-3E ELISA,Anti-gp210,and Anti-sp100）,PBC was confirmed in 16 patients diagnosed with AMA-negative PBC.We confirmed that gp210,and sp100 antibody were detected only in patients with PBC and AMA-positive AIH.Conclusion ELISAS for AMAs and antinuclear antibodies are useful in the differential diagnosis of chronic cholestatic liver disease.