原发性胆汁性肝硬化中自身抗体的检测探讨

目的探讨中国人原发性胆汁性肝硬化患者中自身抗体的存在状况及意义。方法原发性胆汁性肝硬化(PBC)25例、慢性乙型肝炎组20例、健康人20例(年龄、性别匹配),用间接免疫荧光法检测抗核抗体(ANA)、平滑肌抗体(SMA)、抗肝肾微粒抗体1型抗体(anti-LKM1)、抗线粒体抗体(AMA)和抗中性粒细胞胞浆抗体(ANCA),免疫印迹法检测抗肝细胞胞溶质抗原1型抗体(anti-LC1)、抗可溶性肝抗原/肝胰抗原抗体(anti-SLA/LP)、抗肝肾微粒抗体1型(anti-LKM1)、AMA-M2亚型等多种自身抗体.结果PBC中ANA、AMA、M-2检出阳性率分别为48%、96%及96%,组间比较,Pearsonχ2检验在α′=0.02水准,PBC组明显高于其他2组(P<0.01);HBV组、正常对照组间无明显差异。PBC组AMA滴度范围1:320～1:10000,几何平均滴度为1:2252.3,非PBC组AMA滴度范围为1:100～1:320,几何平均滴度为1:147.4。PBC组ANA滴度范围在1:320～1:10000,几何平均滴度为1:827,也较非PBC组1:262.2明显高。SMA、anti-LKM1、anti-LC1、anti-SLA/LP、pANCA、cANCA阳性率在各组均较低,各组比较,差异无统计学意义。PBC组中分别有1例患者ANA、SMA以及ANA、LKM-1同时阳性,此2例患者结合性别、生化、自身抗体等资料符合自身免疫性肝炎(AIH)诊断条件。结论PBC中ANA、AMA及M-2阳性率明显高于正常人及慢性乙型肝炎组,而且存在高滴度的AMA、ANA。而其他自身抗体的阳性率较低。存在PBC/AIH自身免疫性肝病重叠综合征。

Detection of autoantibodies in Chinese patients with primary biliary cirrhosis

Objective To study autoantibodies in Chinese patients with primary biliary cirrhosis. Methods Fourty-five patients with abnormal liver function were chosen and divided into 2 groups:(1) primary biliary cirrhosis(PBC) group, 25 cases;(2) chronic hepatitis B(HBV) group, 20 cases; Meanwhile twenty healthy blood donors were control group. Antinuclear antibody(ANA), smooth muscle antibody(SMA), antimitochondrial antibody(AMA), antibody to liver/kidney microsome type 1(anti-LKM1) and antineutrophil cytoplasmic antibody(ANCA) were tested by indirect immunofluorescence. Then, anti-LKM1,antibody to liver cytosol type 1(anti-LC1),antibody to soluble liver antigen/liver-pancreas(anti-SLA/LP) and subtype 2 of AMA(M-2) were detected by Western blot. Results AMA and M-2 positive were found in 24 of 25 cases with PBC, and ANA positive were found in 48% of PBC.They were significantly different from other groups'. In PBC,AMA titre ranged from 1:320 to 1:10000.Geometric mean of AMA titre was 1:2252.3. In other two groups, the AMA titre ranged from 1:100 to 1:320 and the geometric mean of AMA titre was 1:147.4.The ANA geometric mean titre of PBC was 1:827,which was much higher than mean titre of non-PBC(1:262.2). Autoimmune overlap syndrome was found in 2 patients (AIH/PBC)with PBC. However, fewer other autoantibodies were found in PBC and non-PBC. Conclusion AMA(M-2) and ANA positive can be found easily in PBC than in chronic hepatitis B or healthy people. Meanwhile the titre of AMA and ANA are higher.The detection for ANA and subtype 2 of AMA are helpful for diagnosis primary biliary cirrhosis.