CAJ | 학술논문

目的：探讨多种自身抗体联合检测在原发性胆汁性肝硬化（PBC）诊断中的价值。方法回顾性分析2011年6月－2012年12月在新疆医科大学第一附属医院住院及门诊拟诊或待排除 PBC 患者523例的临床资料，采用间接免疫荧光（IIF）法与免疫印迹（IBT）法测定血清中抗线粒体抗体（AMA）、抗线粒体抗体 M2亚型抗体（AMA-M2）、抗核抗体（ANA）核型及滴度、抗平滑肌抗体（ASMA）、抗肝/肾微粒体抗体（抗-LKM 抗体）、抗肝细胞胞浆抗体（抗-LC1）、抗可溶性肝抗原/肝胰抗原抗体（SLA/LP）。结合 PBC 的诊断标准，分析抗体的诊断价值及临床意义。结果（1）43例 PBC 患者血清自身抗体检测结果中，ANA 的阳性率与非 PBC 患者无统计学差异（P＞0．05），AMA 敏感度最高（79．1％）；AMA、AMA-M2、ANA 胞浆颗粒型、ANA 着丝点型抗体阳性率均高于非 PBC患者（P ＜0．05），特异度分别为73．8％、76．7％、82．9％、79．0％。（2）AMA 与 ANA 着丝点亚型2种抗体并联检测时敏感度增高（93．5％），特异度降低（56．7％）。（3）AMA-M2与 ANA 着丝点亚型2种抗体串联检测时敏感度降（14．0％），特异度增高（97．1％）。结论AMA、AMA-M2及 ANA 着丝点型抗体联合检测对自身免疫性肝病的诊断有重要意义。AMA 与 ANA 着丝点型抗体并联检测用于 PBC 初筛较好。AMA、AMA-M2与 ANA 着丝点型抗体串联检测有利于 PBC 患者的排除。
목적：탐토다충자신항체연합검측재원발성담즙성간경화（PBC）진단중적개치。방법회고성분석2011년6월－2012년12월재신강의과대학제일부속의원주원급문진의진혹대배제 PBC 환자523례적림상자료，채용간접면역형광（IIF）법여면역인적（IBT）법측정혈청중항선립체항체（AMA）、항선립체항체 M2아형항체（AMA-M2）、항핵항체（ANA）핵형급적도、항평활기항체（ASMA）、항간/신미립체항체（항-LKM 항체）、항간세포포장항체（항-LC1）、항가용성간항원/간이항원항체（SLA/LP）。결합 PBC 적진단표준，분석항체적진단개치급림상의의。결과（1）43례 PBC 환자혈청자신항체검측결과중，ANA 적양성솔여비 PBC 환자무통계학차이（P＞0．05），AMA 민감도최고（79．1％）；AMA、AMA-M2、ANA 포장과립형、ANA 착사점형항체양성솔균고우비 PBC환자（P ＜0．05），특이도분별위73．8％、76．7％、82．9％、79．0％。（2）AMA 여 ANA 착사점아형2충항체병련검측시민감도증고（93．5％），특이도강저（56．7％）。（3）AMA-M2여 ANA 착사점아형2충항체천련검측시민감도강（14．0％），특이도증고（97．1％）。결론AMA、AMA-M2급 ANA 착사점형항체연합검측대자신면역성간병적진단유중요의의。AMA 여 ANA 착사점형항체병련검측용우 PBC 초사교호。AMA、AMA-M2여 ANA 착사점형항체천련검측유리우 PBC 환자적배제。
Objective To investigate the diagnostic value of joint autoantibodies detection for primary biliary cirrhosis (PBC).Methods Retrospective analysis was conducted on 523 patients with suspected PBC in the First Affiliated Hospital of Xinjiang Medical University from June 2011 to December 2012.In-direct immunofluorescence (IIF)and immunoblotting (IBT)assay were applied to detect serum autoanti-bodies,including anti-mitochondrial antibody (AMA),AMA-M2,antinuclear antibodies (ANA),an-tismooth muscle antibody (ASMA),anti liver/kidney microsomal antibody (LKM),anti liver cell plasma antibody (LC-1)and anti soluble liver antigen/liver pancreas antigen antibody (SLA/LP).The diagnostic criteria for PBC were taken into consideration to evaluate the value and clinical significance of the antibodies for patients with PBC.Results (1)Among 43 patients with PBC,the positive rate of ANA in the patients with PBC and the patients without PBC was not significantly different (P >0.05);the sensi-tivity of AMA is the highest (79.1%);the specificity of AMA,AMA-M2,ANA (cytoplasmic particle type)and ANA (kinetochore type)were 73.8%,76.7%,82.9%,79.0%,respectively,and the positive rates of AMA,AMA-M2,ANA (cytoplasmic particle type)and ANA (kinetochore type)were higher than those in the patients without PBC (P <0.05).(2)The parallel detection of AMA and ANA (kineto-chore type)showed a higher sensitivity (93.5%)and lower specificity (56.7%),beneficial for the con-firmed diagnosis,(3)The serial detection of AMA-M2 and ANA(kinetochore type)showed a lower sensi-tivity (14.0%)and a rising specificity of 97.1%,beneficial for eliminating the diagnosis of PBC.Conclusion Combined detection of AMA,AMA-M2 and ANA (kinetochore)has important significance for the diag-nosis of autoimmune liver disease.Parallel detection of AMA and ANA (centromere type)is useful for PBC screening.Series detection of AMA,AMA-M2 and ANA (centromere type)is beneficial for the ex-clusion diagnosis of PBC.