不同肝病患者血清自身抗体谱阳性率调查*

doi:10.3969/j.issn.1672-5069.2023.03.017

摘要/Abstract

摘要： 目的调查不同肝病患者血清自身抗体谱阳性率的差异。方法 2019年3月～2022年3月我院诊治的自身免疫性肝病(ALD)患者92例【其中自身免疫性肝炎(AIH)51例,原发性胆汁性胆管炎(PBC)27例和原发性硬化性胆管炎(PSC)14例】,慢性乙型肝炎(CHB)61例,慢性丙型肝炎(CHC)15例,非酒精性脂肪性肝炎(NASH)患者34例,药物性肝损伤(DILI)患者27例健康体检者68例,使用免疫印迹法检测血清自身抗体。结果 ALD患者血清抗线粒体抗体M2亚型(AMA-M2)、抗可溶性肝抗原/抗肝胰抗原抗体(SLA/LP)、抗肝肾微粒体抗体Ⅰ型(LKM-1)、抗跨膜糖蛋白210(gp210)、抗肝细胞溶质抗原Ⅰ型(LC-1)、抗3E、抗早幼粒细胞性白血病(PML)和抗Ro-52阳性率分别为23.9%、13.0%、33.7%、19.6%、26.1%、33.7%、23.9%和55.4%,显著高于其他肝病组(P<0.05); AIH组患者血清抗SLA/LP、抗LKM-1和抗LC-1阳性率显著高于PBC组或PSC组(P<0.05),而PBC患者血清AMA-M2、抗gp210和抗3E阳性率显著高于AIH组或PSC组(P<0.05);24例Ⅱ型AIH患者血清抗LKM-1和抗LC-1阳性率分别为100.0%和66.7%,显著高于21例Ⅰ型(分别为19.0%和19.0%,P<0.05)或6例Ⅲ型患者(分别为16.7%和33.3%,P<0.05),而Ⅲ型患者血清抗SLA/LP阳性率为83.3%,显著高于Ⅰ型的9.5%或Ⅱ型的16.7%,P<0.05)。结论血清自身抗体谱检测是诊断ALD和指导临床分型的重要手段,其他慢性肝病存在一些非特异性阳性,其意义还有待于进一步研究。

关键词: 自身免疫性肝病, 自身抗体, 诊断

Abstract: Objective The aim of this study was to investigate the prevalence of serum autoantibody spectrums in patients with different liver diseases. Methods 92 patients with autoimmune liver diseases (ALD), including autoimmune hepatitis (AIH) in51 cases, primary biliary cholangitis (PBC) in 27 cases and primary sclerosing cholangitis (PSC) in 14 cases, chronic hepatitis B(CHB) in 61 cases and chronic hepatitis C (CHC) in 15 cases, nonalcoholic steatohepatitis (NASH) in 34 cases, drug-induced liver injury (DILI) in 27 cases and healthy persons in 68 cases were recruited in our hospital between March 2019 and March 2022, and serum autoimmune antibody spectrum was detected by immunoblotting. Results The positive rates of anti-mitochondrial antibody M2 subtype (AMA-M2), anti-soluble liver antigen/anti-liver pancreas antibody (SLA/LP), anti-liver kidney microsomal antibody type I (LKM-1), anti-transmembrane glycoprotein 210 (gp210), anti-liver cytosol antigen type I (LC-1), anti-3E, anti-promyelocytic leukemia (PML) and anti-RO-52 in patients with ALD 23.9%,13.0%,33.7%,19.6%,26.1%, 33.7%, 23.9% and 55.4%, significantly higher than in patients with other liver diseases (P<0.05); the positive rates of anti-SLA/LP, anti-LKM-1 and anti-LC-1 in patients with AIH were much higher than in patients with PBC or in patients with PSC(P<0.05), while the positive rates of AMA-M2, anti-gp210 and anti-3E in patients with PBC were much higher than in patients with AIH or in those with PSC(P<0.05); the positive rates of serum anti-LKM-1 and anti-LC-1 in 24 patients with AIH type Ⅱ were 100.0% and 66.7%, much higher than 19.0% and 19.0% (P<0.05) in 21 patients with AIH type Ⅰ or 16.7% and 33.3% (P<0.05) in 6 patients with AIH type Ⅲ, while the positive rate of serum anti-SLA/LP in patients with AIH type Ⅲ was 83.3%, much higher than 9.5% in patients with AIH type Ⅰ or 16.7% in patients with AIH type Ⅱ(P<0.05). Conclusion The detection of serum autoantibody spectrums is a key approach for the diagnosis and clinical classification of patients with ALD, and why they appear, though at low prevalence, in patients with other liver diseases needs further investigation.

Key words: Autoimmune liver diseases, Autoimmune antibody spectrum, Diagnosis

孙璀, 曹琳琳, 刘俊. 不同肝病患者血清自身抗体谱阳性率调查^*[J]. 实用肝脏病杂志, 2023, 26(3): 368-371.

Sun Cui, Cao Linlin, Liu Jun. Prevalence of serum autoantibody spectrums in patients with different liver diseases[J]. Journal of Practical Hepatology, 2023, 26(3): 368-371.

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不同肝病患者血清自身抗体谱阳性率调查^*

Prevalence of serum autoantibody spectrums in patients with different liver diseases

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