抗线粒体抗体M2亚型在非原发性胆汁性肝硬化患者中的特点
항선립체항체M2아형재비원발성담즙성간경화환자중적특점
Differential characteristics ofAMA-M2 autoantibody in primary biliary cirrhosis and non-PBC patients
  • 万方数据
    中华肝脏病杂志 중화간장병잡지
    CHINESE JOURNAL OF HEPATOLOGY
    2015年 5期 343-349 ,共7页

    孙丽梅%王一鹏%刘燕敏%赵艳%张欣%王熠%赵丹彤%张海萍%马胤雪

    손려매%왕일붕%류연민%조염%장흔%왕습%조단동%장해평%마윤설

    肝疾病%抗体,抗核%非原发性胆汁性胆硬化%抗线粒体抗体M2亚型 肝疾病%抗體,抗覈%非原髮性膽汁性膽硬化%抗線粒體抗體M2亞型
    간질병%항체,항핵%비원발성담즙성담경화%항선립체항체M2아형
    Liver diseases%Antibodies,antinuclear%Non-primary biliary cirrhosis%Antimitochondrial antibody M2 subtype
    目的 探讨抗线粒体抗体M2亚型(AMA-M2)在原发性胆汁性肝硬化(PBC)及非PBC患者中的特点. 方法 应用间接免疫荧光法及酶联免疫吸附法检测2011年1月至2013年12月在我院就诊的肝功能异常患者血清中的抗核抗体(ANA)、AMA及AMA-M2,对检测结果及临床资料进行回顾性分析.计数资料以例和百分比描述,采用x2检验和单因素方差分析.结果 5315例肝功能异常患者中,AMA-M2阳性占15.3％ (811/5 315).AMA-M2阳性患者中78.4％ (636/811)的患者确诊为PBC,4.4％(36/811)的患者确诊为PBC/自身免疫性肝炎(AIH)重叠综合征,4.4％(36/811)的患者确诊为药物性肝损伤,6.5％(53/811)的患者确诊为慢性乙型肝炎(CHB),3.3％(27/811)患者确诊为慢性丙型肝炎(CHC),0.6％(5/811)的患者确诊为戊型肝炎,0.9％(7/811)的患者确诊为酒精性肝病,0.5％(4/811)的患者确诊为非酒精性脂肪性肝病,0.8％(6/811)的患者确诊为原发性肝癌,0.1％(1/811)的患者确诊为传染性单核细胞增多症.AMA-M2水平在PBC组与PBC/AIH重叠综合征组比较,P＞ 0.05,差异无统计学意义;但显著高于其他各组,P值均＜0.001,差异均有统计学意义.811例AMA-M2阳性患者中,AMA阳性占88.5％ (718/811),ANA阳性占91.1％ (739/811).PBC组的ALT、AST水平分别为(96.02±115.56)U/L和(94.82±83.32) U/L,显著低于药物性肝损伤组的(527.74±684.65) U/L、(490.60±716.89) U/L和戊型肝炎组的(1015.94±165.55) U/L、(665.4±297.14) U/L,F值分别为8.041、8.066,P值均＜0.05,差异均有统计学意义.PBC组的碱性磷酸酶、γ-谷氨酰转移酶水平分别为(265.16±179.08) U/L、(332.02±279.29) U/L,明显高于CHB组的(135.35±123.17)U/L、(140.27±229.24)U/L和CHC组的(85.65±27.77) U/L、(92.70±125.72)U/L,F值分别为3.911、4.081,P值均＜0.05,差异均有统计学意义.PBC组IgM水平为(4.60±2.67) g/L,显著高于药物性肝损伤组的(1.76±1.15) g/L、CHB组的(2.02±1.41)g/L、CHC组的(1.48±0.92) g/L、戊型肝炎组的(1.40±0.68) g/L、酒精性肝病组的(1.57±1.07)g/L、非酒精性脂肪肝组的(1.05±0.72) g/L和原发性肝癌组的(2.64±2.26) g/L,F=16.83,P值＜ 0.05,差异有统计学意义. 结论 AMA-M2检测对PBC诊断有重要的意义,且AMA-M2在药物性肝损伤、CHB、CHC、戊型肝炎,酒精性肝病、非酒精性脂肪性肝病、原发性肝癌等非自身免疫性疾病患者中仍然有较高阳性率,对上述患者需进一步排除是否合并PBC,对于AMA-M2阳性未诊断为PBC患者要长期密切随访观察,避免错过最佳治疗时期.
    목적 탐토항선립체항체M2아형(AMA-M2)재원발성담즙성간경화(PBC)급비PBC환자중적특점. 방법 응용간접면역형광법급매련면역흡부법검측2011년1월지2013년12월재아원취진적간공능이상환자혈청중적항핵항체(ANA)、AMA급AMA-M2,대검측결과급림상자료진행회고성분석.계수자료이례화백분비묘술,채용x2검험화단인소방차분석.결과 5315례간공능이상환자중,AMA-M2양성점15.3％ (811/5 315).AMA-M2양성환자중78.4％ (636/811)적환자학진위PBC,4.4％(36/811)적환자학진위PBC/자신면역성간염(AIH)중첩종합정,4.4％(36/811)적환자학진위약물성간손상,6.5％(53/811)적환자학진위만성을형간염(CHB),3.3％(27/811)환자학진위만성병형간염(CHC),0.6％(5/811)적환자학진위무형간염,0.9％(7/811)적환자학진위주정성간병,0.5％(4/811)적환자학진위비주정성지방성간병,0.8％(6/811)적환자학진위원발성간암,0.1％(1/811)적환자학진위전염성단핵세포증다증.AMA-M2수평재PBC조여PBC/AIH중첩종합정조비교,P＞ 0.05,차이무통계학의의;단현저고우기타각조,P치균＜0.001,차이균유통계학의의.811례AMA-M2양성환자중,AMA양성점88.5％ (718/811),ANA양성점91.1％ (739/811).PBC조적ALT、AST수평분별위(96.02±115.56)U/L화(94.82±83.32) U/L,현저저우약물성간손상조적(527.74±684.65) U/L、(490.60±716.89) U/L화무형간염조적(1015.94±165.55) U/L、(665.4±297.14) U/L,F치분별위8.041、8.066,P치균＜0.05,차이균유통계학의의.PBC조적감성린산매、γ-곡안선전이매수평분별위(265.16±179.08) U/L、(332.02±279.29) U/L,명현고우CHB조적(135.35±123.17)U/L、(140.27±229.24)U/L화CHC조적(85.65±27.77) U/L、(92.70±125.72)U/L,F치분별위3.911、4.081,P치균＜0.05,차이균유통계학의의.PBC조IgM수평위(4.60±2.67) g/L,현저고우약물성간손상조적(1.76±1.15) g/L、CHB조적(2.02±1.41)g/L、CHC조적(1.48±0.92) g/L、무형간염조적(1.40±0.68) g/L、주정성간병조적(1.57±1.07)g/L、비주정성지방간조적(1.05±0.72) g/L화원발성간암조적(2.64±2.26) g/L,F=16.83,P치＜ 0.05,차이유통계학의의. 결론 AMA-M2검측대PBC진단유중요적의의,차AMA-M2재약물성간손상、CHB、CHC、무형간염,주정성간병、비주정성지방성간병、원발성간암등비자신면역성질병환자중잉연유교고양성솔,대상술환자수진일보배제시부합병PBC,대우AMA-M2양성미진단위PBC환자요장기밀절수방관찰,피면착과최가치료시기.
    Objective To explore the differential characteristics of the AMA-M2 autoantibody in patients with primary biliary cirrhosis (PBC) and non-PBC patients.Methods Patients with abnormal liver function at the Capital Medical University affiliated to Beijing You-an Hospital were enrolled in this study between January 2011 and December 2013.Serum levels ofANA,AMA and AMA-M2 were detected by indirect fluorescence assay and enzyme-linked immunosorbent assay.The patients' clinical data was obtained for retrospective analysis.Statistical analyses were performed using the SPSS 16.0 software.Enumeration data have been presented as numbers and percentages,and were analyzed using the chi-square test and one-way ANOVA test.Results Of the 5315 patients with abnormal liver function,15.3％ (811/5315) were AMA-M2 positive patients;among those 811 patients,78.4％ (636) had PBC,4.4％ (36) had PBC overlapping with autoimmune hepatitis (AIH),4.4％ (36) had drug-induced liver injury,6.5％ (53) had hepatitis B,3.3％ (27) had hepatitis C,0.6％ (5) had hepatitis E,0.9％ (7) had alcoholic liver disease,0.5％ (4) had non-alcoholic fatty liver,0.8％ (6) had primary hepatic carcinoma,and 0.1％ (1) had infectious mononucleosis.Serum AMA-M2 level was significantly higher in the PBC patients (vs.other groups,p ＜ 0.001) with the exception of the patients with PBC/AIH overlap syndrome.Among the 811 patients with AMA-M2 positivity,88.5％ (718) showed AMA positivity and 91.1％ (739) showed ANA positivity.Serum alanine transferase (ALT) and aspartate transferase (AST) levels were significantly higher in the drag-induced liver injury patients (527.74±684.65 U/L,490.60±716.89 U/L) and the hepatitis E patients (1015.94±165.55 U/L,665.4±297.14 U/L) than in the PBC patients (96.02±115.56 U/L,94.82±83.32 U/L) (ALT:F =8.041,p ＜ 0.001,p ＜ 0.001;AST:F =8.066,p ＜ 0.001,p ＜ 0.001).Serum alkaline phosphatase (ALP;265.16±179.08 U/L) and glutamyl transferase (GGT;332.02±279.29 U/L) were significantly higher in the PBC patients than in the hepatitis B patients (135.35±123.17 U/L,140.27±229.24 U/L) and the hepatitis C patients (85.65±27.77 U/L,92.70± 125.72 U/L) (ALP:F=3.911,p =0.01,p =0.001;GGT:F=4.081,p ＜ 0.001,p ＜ 0.001).The serum IgM level was significantly higher in the PBC patients (4.60±2.67 g/L) than in the patients with drug-induced liver injury (1.76± 1.15 g/L),hepatitis B (2.02± 1.41 g/L),hepatitis C (1.48±0.92 g/L),hepatitis E (1.40±0.68 g/L),alcoholic liver disease (1.57±1.07 g/L),non-alcoholic fatty liver (1.05±0.72 g/L),and primary hepatic carcinoma (2.64±2.26 g/L) (F=16.83,p＜0.001,p＜0.001,p＜0.001,p＜0.05,p＜0.01,p＜0.05 respectively).Conclusions Although detection of serum AMA-M2 is an important feature of PBC diagnostic testing,there is a high ratio of serum AMA-M2 detected in patients with drug-induced liver injury,hepatitis B,C and E,alcoholic liver disease,non-alcoholic fatty liver,and primary hepatic carcinoma.The AMA-M2 positive non-PBC patients still require close observation to watch for future development of PBC.
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