不同类型自身免疫性肝病患者肝组织炎症因子表达的变化

doi:10.3969/j.issn.1672-5069.2020.03.014

摘要/Abstract

摘要： 目的探讨不同类型自身免疫性肝病(AILD)患者肝组织炎症因子表达的变化。方法 2016年12月～2018年12月我院肝病科收治的AILD患者74例,其中自身免疫性肝炎(AIH)患者19例,原发性胆汁性肝硬化(PBC)患者42例,自身免疫性肝炎/原发性胆汁性肝硬化重叠综合症(AIH/PBC OS)患者13例。采用免疫组化法检测肝穿组织白介素-12(IL-12)、IL-17和干扰素-γ(IFN-γ)表达情况。结果 AIH、PBC和AIH-PBC OS患者血清ALT水平分别为(132.5±12.5)U/L、(40.1±8.4)U/L和(166.2±16.3)U/L,AST水平分别为(120.3±11.7)U/L、(52.8±5.6)U/L和(194.7±18.3)U/L,差异显著(P<0.05);血清ALP水平分别为(98.0±9.2)U/L、(323.5±30.9)U/L和(257.1±24.1)U/L,血清GGT水平分别为(49.1±4.7)U/L、(236.8±22.6)U/L和(376.7±35.5)U/L,差异显著(P<0.05);AIH、PBC和AIH-PBC OS组患者肝组织IL-12表达阳性率无统计学差异(分别为15.8%、7.1%和15.4%,P>0.05),肝组织IL-17阳性表达率无统计学差异(分别为73.7%、76.2%和76.9%,P<0.05),肝组织IFN-γ阳性表达率无统计学差异(分别为68.4%、85.7%和76.9%,P<0.05);AIH患者血清抗肝肾微粒体I型抗体(LKM-1)、抗可溶性肝抗原/肝胰抗原抗体(SLA/LP)阳性率分别为21.1%和10.8%,均显著高于PBC组或AIH-PBC OS患者(分别为0.0%和0.0%,和0.0%和0.0%,P<0.05);PBC患者血清抗sp100抗体阳性率为19.0%,显著高于AIH组(0.0%)或AIH-PBC OS患者(7.7%,P<0.05);AIH-PBC OS组血清抗gp210抗体阳性率为38.5%,显著高于AIH组(0.0%,P<0.05),AIH-PBC OS组患者血清抗线粒体M2抗体(AMA-M2)阳性率为100.0%,显著高于AIH组(0.0%)或PBC组(73.8%,P<0.05);AIH患者血清ANA和SMA阳性率分别为94.7%和78.9%,显著高于PBC患者(分别为19.0%和19.0%,P<0.05)。结论不同类型AILD患者血清自身抗体呈交叉阳性现象,肝组织炎性因子检测对鉴别诊断没有意义,常规肝功能指标仍对诊断起关键作用。

关键词: 自身免疫性肝炎, 原发性胆汁性肝硬化, 自身免疫性肝炎/原发性胆汁性肝硬化重叠综合症, 自身抗体 , ,

Abstract: Objective The aim of this study was to investigate the expression of inflammatory factors in liver tissues of patients with different types of autoimmune liver diseases (AILD). Methods 74 patients with AILD, including autoimmune hepatitis (AIH) in 19, primary biliary cirrhosis (PBC) in 42, and autoimmune hepatitis/primary biliary cirrhosis overlap syndrome (AIH-PBC OS) in 13, were recruited in this study between December 2016 and December 2018, and the expression of interleukin-12 (IL-12), IL-17 and interferon-γ were detected by immunohistological staining. Results Serum ALT levels in patients with AIH, PBC and AIH-PBC OS were (132.5±12.5)U/L, (40.1±8.4)U/L and (166.2±16.3)U/L, serum AST levels were (120.3±11.7)U/L, (52.8±5.6)U/L and (194.7±18.3)U/L, significantly different among them (P<0.05); serum ALP levels were (98.0±9.2)U/L, (323.5±30.9)U/L and (257.1±24.1)U/L, and serum GGT levels were (49.1±4.7)U/L, (236.8±22.6)U/L and (376.7±35.5)U/L, respectively, significantly different (P<0.05); the positive rates of IL-12 in liver tissues of patients with AIH, PBC and AIH/PBC OS were not significantly different (15.8%, 7.1% and 15.4%, respectively, P>0.05), the positive rates of IL-17 were 73.7%, 76.2% and 76.9% (P<0.05), and the positive rates of IFN-γ were 68.4%, 85.7% and 76.9%, respectively, all not significantly different (P<0.05); the positive rates of anti-hepatorenal microsome type I antibody (LKM-1) and anti-soluble liver antigen/liver pancreatic antigen antibody (SLA/LP) in patients with AIH 21.1% and 10.8%, significantly higher than 0.0% and 0.0% in patients with PBC or 0.0% and 0.0% in patients with AIH-PBC OS (P<0.05); serum anti-sp100 positive rate in patients with PBC was 19.0%, significantly higher than 0.0% in patients with AIH or 7.7% in patients with AIH-PBC OS (P<0.05); serum anti- gp210 positive rate in patients with AIH-PBC OS was 38.5%, significantly higher than 0.0% in patients with AIH(P<0.05) and anti-mitochondrial M2 antibody (AMA-M2) positive rate in patients with AIH-PBC OS was 100.0%, significantly higher than 0.0% in patients with AIH or 73.8% in patients with PBC (P<0.05); serum antinuclear antibody (ANA) and anti-smooth muscle actin (SMA) positive rates in patients with AIH were 94.7% and 78.9%, significantly higher than 19.0% and 19.0% in patients with PBC (P<0.05). Conclusion Serum autoantibodies in patients with different types of AILD are cross-positive in some instance, and the expression of inflammatory cytokines are also not differential sometime, Therefore, the clinical diagnosis should be made by the combination of routine biochemical parameters and clinical manifestations.

Key words: Autoimmune hepatitis, Primary biliary cirrhosis, Autoimmune hepatitis /primary biliary cirrhosis overlap syndrome, Autoantibodies

冯静,罗思剑,李靖,刘岚剑,邱国院,王翠,龚成丽. 不同类型自身免疫性肝病患者肝组织炎症因子表达的变化[J]. 实用肝脏病杂志, 2020, 23(3): 356-359.

Feng Jing, Luo Sijian, Li Jing,et al. Expression of inflammatory factors in liver tissues of patients with different types of autoimmune liver diseases[J]. Journal of Practical Hepatology, 2020, 23(3): 356-359.

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