自身免疫性肝炎患者血清多反应性IgG水平变化及其临床意义探讨*

doi:10.3969/j.issn.1672-5069.2026.02.015

摘要/Abstract

摘要： 目的探讨自身免疫性肝炎(AIH)患者血清多反应性IgG(pIgG)水平变化及其临床意义,旨在为临床诊疗提供参考依据。方法 2022年9月～2024年9月我院诊治的AIH患者48例,均接受肝活检和标准免疫抑制治疗6个月。常规检测血清IgG水平,采用ELISA试剂盒检测并自动计算pIgG水平。结果 29例临床重度AIH患者血清ALT、AST、TBIL和pIgG水平分别为(152.8±35.2) U/L、(128.3±32.6)U/L、(73.1±23.5)μmol/L和(83.5±23.2)mg/L,均显著高于19例轻中度患者【分别为(72.5±15.6) U/L、(68.3±16.8)U/L、(27.8±6.3)μmol/L和(45.4±15.8)mg/L,P<0.05】,而两组血清IgG水平比较差异不具有统计学意义(P>0.05);31例肝组织炎症活动度G3/G4患者血清pIgG水平为(84.6±25.0)mg/L,显著高于17例G1/G2患者【(44.5±16.3)mg/L,P<0.05】;在治疗6个月末,38例(79.2%)获得生化学应答完全,获得不完全10例(20.8%);应答完全患者基线血清pIgG水平为(42.0±11.7) mg/L,显著低于应答不完全患者【(81.8±17.2)mg/L,P<0.05】,完全应答与不完全应答组血清IgG水平比较,差异不具有统计学意义(P>0.05)。结论血清pIgG水平可能帮助评估AIH患者疾病活动度和预测治疗应答,是否可作为新型生物标志物应用于临床,值得深入研究。

关键词: 自身免疫性肝炎, 免疫抑制治疗, 多反应性IgG, 治疗

Abstract: Objective The purpose of this study was to investigate the changes and implication of polyreactive IgG (pIgG)levels in patients with autoimmune hepatitis (AIH). Methods 48 patients with AIH were recruited in our hospital between September 2022 and June 2024, all patients underwent liver biopsy and were treated with standardized immunosuppressive therapy for six months. Serum pIgG level was assayed and calculated. Results Serum ALT, AST, bilirubin and pIgG levels at baseline in 29 patients with severe degree of liver activity were (152.8±35.2) U/L, (128.3±32.6)U/L, (73.1±23.5)μmol/L and (83.5±23.2)mg/L, all significantly higher than [(72.5±15.6) U/L, (68.3±16.8)U/L, (27.8±6.3)μmol/L and (45.4±15.8)mg/L, respectively, P<0.05] in 19 patients with mild to moderate degree, while there was no significant difference as respect to serum IgG levels between them (P>0.05); serum pIgG level in 31 patients with liver histoactivity of G3/G4 was (84.6±25.0)mg/L, much higher than [(44.5±16.3)mg/L, P<0.05] in 17 patients with G1/G2; by end of six-month immunosuppressive therapy, complete biochemical response (CR) was obtained in 38 cases (79.2%), and 10 patients (20.8%)didn’t; serum pIgG level in patients with CR was (42.0±11.7) mg/L, much lower than [(81.8±17.2)mg/L, P<0.05] in non-responders, while there was no significant difference as respect to serum IgG levels between the two groups (P>0.05). Conclusion Serum pIgG level might serve as a novel biomarker for assessing disease activity and predicting treatment response in patients with AIH, which warranted further clinical investigation.

Key words: Autoimmune hepatitis, Standardized immunosuppressive therapy, Polyreactive IgG, Therapy

张旭晖, 张会品. 自身免疫性肝炎患者血清多反应性IgG水平变化及其临床意义探讨^*[J]. 实用肝脏病杂志, 2026, 29(2): 221-224.

Zhang Xuhui, Zhang Huipin. Clinical implication of polyreactive IgG levels in patients with autoimmune hepatitis[J]. Journal of Practical Hepatology, 2026, 29(2): 221-224.

参考文献

[1] Chen Y, Chen R, Li H, et al. Clinical management of autoimmune liver diseases: juncture, opportunities, and challenges ahead. Immunol Res, 2025, 73(1):67.
[2] Leng L, Li Y, Xu T, et al. Causal association between circulating inflammatory proteins and autoimmune liver disease: a bidirectional two-sample mendelian randomization study. Immunotargets Ther, 2025, 14:279-289.
[3] Huang D, Shi J. Real-world case supporting drug-induced autoimmune hepatitis: Updated insights and analysis of the FAERS data. Liver Int, 2025, 45(4):e70055.
[4] Wang R, Lin Q, Sheng L, et al. Optimizing the tapering scheme of corticosteroid treatment for acute onset of autoimmune hepatitis. J Autoimmun, 2025, 152:103387.
[5] Engel B, Diestelhorst J, Hupa-Breier KL, et al. Detection of polyreactive immunoglobulin G facilitates diagnosis in children with autoimmune hepatitis. Hepatol Int, 2024, 18(4):1214-1226.
[6] Taubert R, Engel B, Diestelhorst J, et al. Quantification of polyreactive immunoglobulin G facilitates the diagnosis of autoimmune hepatitis. Hepatology, 2022, 75(1):13-27.
[7] Argyropoulou OD, Gunti S, Kapsogeorgou EK, et al. Decrease in the ratio of polyreactive IgG titers with IgG concentration is associated with long-term complications of primary Sjögren's syndrome. Clin Exp Rheumatol, 2018, 112(3):239-240.
[8] Trivedi PJ, Hirschfield GM, Adams DH, et al. Immunopathogenesis of primary biliary cholangitis, primary sclerosing cholangitis and autoimmune hepatitis: Themes and concepts. Gastroenterology, 2024, 166(6):995-1019.
[9] Liu Y, Hao H, Hou T. Concanavalin A-induced autoimmune hepatitis model in mice: Mechanisms and future outlook. Open Life Sci, 2022, 17(1):91-101.
[10] Scheid JF, Mouquet H, Kofer J, et al. Differential regulation of self-reactivity discriminates between IgG⁺ human circulating memory B cells and bone marrow plasma cells. Proc Natl Acad Sci U S A, 2011, 108(44):18044-18048.
[11] Mietzner B, Tsuiji M, Scheid J, et al. Autoreactive IgG memory antibodies in patients with systemic lupus erythematosus arise from nonreactive and polyreactive precursors. Proc Natl Acad Sci U S A, 2008, 105(28):9727-9732.
[12] 中华医学会肝病学分会.自身免疫性肝炎诊断和治疗指南(2021).中华肝脏病杂志,2022,30(5):482-492.
[13] 窦婧, 徐强, 王转国, 等. 血清IgG低水平和转氨酶正常的AIH患者临床和肝组织病理学特征分析. 实用肝脏病杂志, 2023, 26(2):222-225.
[14] Qiu D, Wang Q, Wang H, et al. Validation of the simplified criteria for diagnosis of autoimmune hepatitis in Chinese patients. J Hepatol, 2011, 54(2):340-347.
[15] 朱家瑞, 葛绍锋, 叶桂云, 等. 自身免疫性肝炎患者外周血NLR和nCD64指数变化及其临床意义探讨. 实用肝脏病杂志, 2024, 27(5):717-720.
[16] Laschtowitz A, Zachou K, Lygoura V, et al. Histological activity despite normal ALT and IgG serum levels in patients with autoimmune hepatitis and cirrhosis. JHEP Rep, 2021, 3(4):100321.
[17] Abe K, Takahashi A, Nozawa Y, et al. The utility of IgG, IgM, and CD138 immunohistochemistry in the evaluation of autoimmune liver diseases. Med Mol Morphol, 2014, 47(3):162-168.
[18] Lee BT, Wang Y, Yang A, et al. IgG:IgM ratios of liver plasma cells reveal similar phenotypes of primary biliary cholangitis with and without features of autoimmune hepatitis. Clin Gastroenterol Hepatol, 2021, 19(2):397-399.
[19] Hsu M, Ju JY, Pearson MM, et al. IgG and IgM immunohistochemistry in primary biliary cholangitis (PBC) and autoimmune hepatitis (AIH) liver explants. Am J Clin Pathol, 2022, 158(6):770-773.
[20] Varadarajan A, Rastogi A, Maiwall R, et al. Serum IgG level in autoimmune liver diseases and its significance: Is there a need to revisit existing criteria? Experience from a tertiary care center. Indian J Pathol Microbiol, 2024, 67(4):846-851.

自身免疫性肝炎患者血清多反应性IgG水平变化及其临床意义探讨^*

Clinical implication of polyreactive IgG levels in patients with autoimmune hepatitis

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 15

编辑推荐

Metrics

本文评价

[1]	王玲玲, 张召, 徐玉. 影响Peg-IFNα-2b治疗HBeAg阴性慢性乙型肝炎患者早期病毒学应答的因素分析^*[J]. 实用肝脏病杂志, 2026, 29(2): 175-178.
[2]	何红梅, 沙志虎, 邵建国, 徐姝嫣. 恩替卡韦联合软肝散结方治疗慢性乙型肝炎患者临床疗效研究^*[J]. 实用肝脏病杂志, 2026, 29(2): 179-182.
[3]	刘静, 刘天泽, 赵传魁, 石光英. 索磷布韦/维帕他韦治疗慢性丙型肝炎合并T2DM患者疗效研究^*[J]. 实用肝脏病杂志, 2026, 29(2): 195-198.
[4]	孙燕军, 许丽萍, 周凌, 朱金凤. 司美格鲁肽治疗2型糖尿病合并非酒精性脂肪性肝病患者疗效初步临床研究^*[J]. 实用肝脏病杂志, 2026, 29(2): 209-212.
[5]	张小兰, 陈锐, 陈勄, 张羽萍. 老年自身免疫性肝炎患者不完全应答患者临床特征及其影响因素分析^*[J]. 实用肝脏病杂志, 2026, 29(2): 225-228.
[6]	黎春宇, 邱源, 明全. 血浆置换序贯双重血浆分子吸附系统治疗慢加急性乙型肝炎肝衰竭患者疗效研究^*[J]. 实用肝脏病杂志, 2026, 29(2): 237-240.
[7]	孙琴, 蒋振兴, 邵剑锋. DPMAS序贯半量血浆置换治疗慢加急性乙型肝炎肝衰竭患者疗效研究^*[J]. 实用肝脏病杂志, 2026, 29(2): 241-244.
[8]	周慧敏, 王娜, 刘晶晶, 郭亚荣, 柴宝. 内镜下硬化剂治疗肝硬化并发食管静脉曲张破裂出血患者心肌损伤临床研究^*[J]. 实用肝脏病杂志, 2026, 29(2): 265-268.
[9]	何阳, 张屹俊, 侯毅斌, 周粟, 杨柏帅, 袁敏. 经颈静脉肝内门体分流术治疗肝硬化并发脾功能亢进症患者疗效研究[J]. 实用肝脏病杂志, 2026, 29(2): 277-280.
[10]	蒋楠, 刘泉, 郝福荣. 免疫联合SBRT治疗中晚期原发性肝癌患者疗效与安全性分析^*[J]. 实用肝脏病杂志, 2026, 29(2): 285-288.
[11]	李杰, 季敏君, 刘晓艳, 王庆庆, 倪鑫. 经肝动脉灌注化疗栓塞术联合仑伐替尼治疗中晚期肝细胞癌患者临床疗效研究^*[J]. 实用肝脏病杂志, 2026, 29(2): 289-292.
[12]	孙志青, 赵彦娜, 贺祥昆, 葛晨. 损伤控制性手术原则治疗原发性肝癌自发性破裂大出血患者止血效果研究^*[J]. 实用肝脏病杂志, 2026, 29(2): 293-296.
[13]	刘成宸, 颜勋, 张明, 陆峰. 双镜联合手术治疗胆囊结石合并胆总管结石患者临床效果研究^*[J]. 实用肝脏病杂志, 2026, 29(2): 313-316.
[14]	万伟, 章雨晨, 沈宇. 经皮经肝胆管穿刺引流术治疗急性胆道感染患者疗效研究^*[J]. 实用肝脏病杂志, 2026, 29(2): 317-320.
[15]	黎健, 罗磊, 杨文龙. 丙型肝炎微消除研究进展^*[J]. 实用肝脏病杂志, 2026, 29(1): 9-12.