自身免疫性肝炎患者血清抗延胡索酸水合酶抗体检测及其临床意义探讨*

doi:10.3969/j.issn.1672-5069.2020.04.015

摘要/Abstract

摘要： 目的探讨血清抗延胡索酸水合酶抗体(抗-FH)诊断自身免疫性肝炎(AIH)及其鉴别诊断的价值。方法 2018年2月～2019年5月我院内科收治的166例肝病患者,其中AIH患者52例,慢性乙型肝炎(CHB)患者81例和药物性肝损伤(DILI)患者33例,采用ELISA法检测血清抗-FH和抗核抗体(ANA)。结果 AIH患者血清GGT、ALP和IgG水平分别为(304.6±28.1)U/L、(258.1±24.0)U/L和(24.7±1.9)g/L,显著高于CHB患者【分别为(104.5±12.3)U/L、(85.7±9.2)U/L和(15.2±1.5)g/L,P<0.05】,其血清IgG水平也显著高于DILI患者【(14.8±1.2)g/L,P<0.05】,三组血清TBIL和ALT水平差异无统计学意义(P>0.05);AIH组血清抗-FH阳性率为36.5%,显著高于DILI组的6.1%或CHB组的3.7%(P<0.05);AIH组血清ANA阳性率为73.1%,显著高于DILI组的54.5%或CHB组的50.6%(P<0.05);血清抗-FH诊断AIH的灵敏度、特异度、约登指数、阳性预测值和阴性预测值分别为36.5%、95.6%、0.3、35.2%和76.8%,而血清抗-FH联合ANA诊断的灵敏度、特异度、约登指数、阳性预测值和阴性预测值则分别为76.9%、44.7%、0.2、38.8%和80.9%,提高了诊断的灵敏度,但特异度大大降低。结论血清抗-FH诊断AIH患者的特异性很高,但灵敏度较低,在特定情况下对鉴别诊断可能具有很大的帮助。

关键词: 自身免疫性肝炎, 抗延胡索酸水合酶抗体, 抗核抗体, 诊断

Abstract: Objective The aim of this study was to explore the diagnostic value of serum anti-fumarate hydratase (anti-FH) in patients with autoimmune hepatitis (AIH). Methods 166 patients with liver disease, including AIH in 52, chronic hepatitis B (CHB) in 81 and drug-induced liver injury (DILI)]in 33, were recruited in our hospital between February 2018 and May 2019. Serum anti-FH and antinuclear antibody were detected by ELISA. Results Serum GGT, ALP and IgG levels in patients with AIH were (304.6±28.1)U/L, (258.1±24.0)U/L and (24.7±1.9)g/L, significantly higher than 【(104.5±12.3)U/L, (85.7±9.2)U/L and (15.2±1.5)g/L, respectively, P<0.05】 in patients with CHB and serum IgG level was also much higher than 【(14.8±1.2)g/L, P<0.05】 in patients with DILI, and serum bilirubin and ALT levels in the three groups were not significantly different (P>0.05); serum anti-FH positive rate in patients with AIH was 36.5%, significantly higher than 6.1% in patients with DILI or 3.7%(P<0.05) in those with CHB; serum ANA positive rate in patients with AIH was 73.1%, significantly higher than 54.5% in DILI patients or 50.6%(P<0.05) in CHB patients; the sensitivity (Se), specificity (Sp), Yorden index, positive predictive value and negative predictive value by serum anti-FH in diagnosing AIH were 36.5%, 95.6%, 0.3, 35.2% and 76.8%, while those by serum anti-FH and ANA combination were 76.9%, 44.7%, 0.2, 38.8% and 80.9%, respectively, meaning the Se increased, while the Sp decreased greatly. Conclusion Serum anti-FH has a high diagnostic specificity for patients with AIH, which under some circumstances might have a good differential effect in clinical practice.

Key words: Autoimmune hepatitis, Anti-fumarate hydratase, Antinuclear antibody, Diagnosis

程源, 张洋, 毛海洲, 段红光. 自身免疫性肝炎患者血清抗延胡索酸水合酶抗体检测及其临床意义探讨^*[J]. 实用肝脏病杂志, 2020, 23(4): 512-515.

Cheng Yuan, Zhang Yang, Mao Haizhou, et al. Diagnostic value of serum anti-tenoxalate hydrase antibody in patients with AIH[J]. Journal of Practical Hepatology, 2020, 23(4): 512-515.

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自身免疫性肝炎患者血清抗延胡索酸水合酶抗体检测及其临床意义探讨^*

Diagnostic value of serum anti-tenoxalate hydrase antibody in patients with AIH

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