血清腺苷脱氨酶和淀粉样蛋白A辅助诊断自身免疫性肝炎患者临床价值分析*

doi:10.3969/j.issn.1672-5069.2020.04.014

摘要/Abstract

摘要： 目的分析应用血清腺苷脱氨酶(ADA)和淀粉样蛋白A(SAA)辅助诊断自身免疫性肝炎(AIH)患者的临床价值。方法 2017年1月～2018年12月我院收治的AIH患者60例,乙型肝炎、丙型肝炎和酒精性肝炎患者98例和同期健康人100例,采用胶乳比浊法检测血清SAA,采用谷氨酸脱氢酶偶联速率法检测血清ADA,采用间接免疫荧光法检测血清抗核抗体(ANA),采用免疫印迹法检测血清抗肝肾微粒体Ⅰ型(LKM-1)、抗肝细胞浆抗体Ⅰ型(LC-1)、抗可溶性肝抗原/肝胰抗原(SLA/LP)。结果 AIH组血清SAA水平为(58.7±6.2)mg/L,显著高于非AIH组【(12.3±2.5)mg/L,P<0.05】或健康人【(6.3±1.2)mg/L,P<0.05】,血清ADA水平为(88.4±10.1)U/L,显著高于非AIH组【(17.7±3.0)U/L,P<0.05】或健康人【(10.3±2.1)mg/L,P<0.05】;AIH组血清ANA、抗LKM-1和抗SLA/LP阳性率分别为68.3%、16.7%和11.7%,而仅非AIH组血清ANA阳性率为42.9%(P<0.05); 在本组AIH患者,血清ANA诊断的灵敏度、特异度和准确性分别为68.3%、57.1%和60.0%,而以血清SAA＞52.1 mg/L或ADA＞77.9 U/L为截断点,对血清ALT升高者在排除常见病因引起的肝功能损伤后,其辅助诊断AIH的灵敏度、特异度和准确性分别被提高到76.7%、89.8%和70.4%。结论对血清自身抗体阴性者,在排除常见的引起肝损伤的病因后,血清ADA或/和SAA异常升高,有助于对AIH的诊断,值得进一步探讨。

关键词: 自身免疫性肝炎, 淀粉样蛋白A, 腺苷脱氨酶, 抗核抗体, 诊断

Abstract: Objective The aim of this study was to analyze the auxiliary diagnostic value of serum adenosine deaminase (ADA) and serum amyloid A (SAA) protein in patients with autoimmune hepatitis (AIH). Methods 60 patients with AIH, 98 patients with hepatitis B or C or alcoholic hepatitis (non-AIH group), and 100 healthy persons with normal physical examination Results were recruited between January 2017 and December 2018, and serum SAA and ADA, as well as serum antinuclear antibody (ANA), anti-liver-kidney microsomal antibody (LKM-1), anti-hepatocyte cytoplasmic antibody type I ( LC-1) and anti-soluble liver antigen/hepatic pancreatic antigen (SLA/LP) were detected. Results In AIH patients, serum SAA level was (58.7±6.2)mg/L, significantly higher than 【(12.3±2.5)mg/L, P<0.05】 in non-AIH patients or 【(6.3±1.2)mg/L, P<0.05】 in healthy persons, and serum ADA level was (88.4±10.1)U/L, significantly higher than 【(17.7±3.0)U/L, P<0.05】 in non-AIH patients or 【(10.3±2.1)mg/L, P<0.05】 in healthy persons; the prevalence of serum ANA, anti-LKM-1 and anti-SLA/LP in patients with AIH were 68.3%, 16.7% and 11.7%, while only 42.9%(P<0.05) of patients with non-AIH had serum ANA positive; in our series, the diagnostic sensitivity (Se), specificity (Sp) and accuracy (Ac) ANA were 68.3%, 57.1% and 60.0%, while when serum SAA level greater than 52.1 mg/L of serum or serum ADA level greater than 77.9 U/L was set as the cut-off-value, their auxiliary diagnostic Se, Sp and Ac were 76.7%, 89.8% and 70.4% on condition of exclusion of common etiologic reasons, such as viral hepatitis, fatty liver and drug-induced liver injuries in individuals with serum ALT elevation and serum autoimmune antibody negative. Conclusion As for individuals with serum ALT elevation and serum autoimmune antibody negative, the autoimmune hepatitis should be suspected as serum ADA or/and SAA level increases as common liver injury causes are excluded.

Key words: Autoimmune hepatitis, Serum amyloid A, Adenosine deaminase, Antinuclear antibody, Diagnosis

文琼花, 唐敏云, 魏玉, 陈少文. 血清腺苷脱氨酶和淀粉样蛋白A辅助诊断自身免疫性肝炎患者临床价值分析^*[J]. 实用肝脏病杂志, 2020, 23(4): 508-511.

Wen Qionghua, Tang Minyun, Wei Yu, et al. Auxiliary diagnostic value of serum adenosine deaminase and amyloid A protein in patients with autoimmune hepatitis[J]. Journal of Practical Hepatology, 2020, 23(4): 508-511.

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血清腺苷脱氨酶和淀粉样蛋白A辅助诊断自身免疫性肝炎患者临床价值分析^*

Auxiliary diagnostic value of serum adenosine deaminase and amyloid A protein in patients with autoimmune hepatitis

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