IgM与IgG在自身免疫性肝病诊断中的价值

目的比较自身免疫性肝病中自身免疫性肝炎（AIH）、原发性胆汁性肝硬化（PBC）及其重叠综合征（0s）的临床、血清学及病理学特点，并检测血清及肝组织中IgM及IgG的比例，评估其对AIH及PBC的鉴别诊断意义。方法回顾性分析106例自身免疫性肝病病例，采用ELISA法测定三组外周血IgM和IgG水平，免疫组化法检测并比较其肝组织中炎性细胞IgM及IgG的表达情况。结果比较AIH、PBC及0s患者血清中IgM和IgG水平及肝组织中的IgM和IgG阳染炎性细胞比例后发现：PBC组IgM／IgG比值较AIH组高（0=9．584，P〈0．05）；在肝组织汇管区，AIH组以IgM＋／IgG＋〈1者为主，占66．7％（22／33）；PBC组以IgM＋／IgG＋≥1者为主，占100％（10／10），其中tgM＋／IgG＋=1者占50％；OS组IgM＋／IgG＋≥1者，占84．6％（11／13）。PBC组与AIH组IgM＋／IgG＋比较，x^2=11．113，P〈0．05；OS组与AIH组比较，）（2=7．881，P〈0．05。结论血清及肝组织中IgM／IgG比值对AIH、PBC及其OS的鉴别诊断具有一定帮助。

Effects of IgM and IgG in autoimmune liver disease diagnosis

Objective To compare the clinical, serological and pathologic characteristics among autoimmune hepatitis （ AIH）, primary biliary cirrhosis （PBC） and their overlap syndrome （ OS）, to detect the ratio of IgM and IgG in serum and liver tissue, and to assess the values of IgM and IgG in the differential diagnoses of AIH and PBC. Methods One hundred and six cases were analyzed. The expressions of IgM and IgG cells in liver tissues were evaluated by immunostaining, and their titers in peripheral blood were measured by ELISA. Results IgM/IgG ratio of serous inflammatory cells was higher in PBC group than that of in AIH group（x^2 =9.584,P 〈0.05）. In liver tissues,AIH cases showed that IgM ＋/IgG ＋ 〈 1 was the majority, accounting for 66. 7% （22/33）. IgM ＋/IgG ＋ 〉I 1 accounted for 100% （10/10）in PBC group and 84. 6 % （ 11/13 ） in OS group. But half of PBC cases showed slightly difference between IgG and IgM. The differences of IgM ＋/IgG ＋ in PBC group and AIH group had statistical significance （ x^2 = 11.113, P 〈 0.05 ） ; and the differences of IgM ＋/IgG ＋ in OS group and AIH group had statistical significance （ X^2 = 7. 881, P 〈 0. 05 ）. Conclusions IgM/IgG ratio of inflammatory cells in serum and liver biopsy tissues can be a valuable parameter for differentiating PBC from AIH.