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多种自身抗体联合检测在原发性胆汁性肝硬化中的诊断价值
作者:杜慧慧 李青梅 周希禛 刘洋 王俐琼 王磊 张玮 
单位:上海市中医药大学附属龙华医院 上海 200032 
关键词:肝硬化 胆汁性 抗体 
分类号:
出版年,卷(期):页码:2013,5(1):19-23
摘要:

摘要:目的  探讨3种自身抗体(抗-线粒体M2亚型、抗-gp210、抗-Sp100)的联合检测在原发性胆汁性肝硬化中的诊断价值。方法  选择2000例隐匿性肝炎患者,根据疾病诊断分为原发性胆汁性肝硬化(PBC)组129例(6.45%)、自身免疫性肝炎(AIH)组205例(10.25%)、AIH-PBC重叠综合征组15例(0.75%)、脂肪肝组514例(25.70%)、药物性肝炎组379例(18.96%)、其他不明原因肝炎组758例(37.90%)。选择同期健康者15例作为对照组。采用ELISA法检测2000例隐匿性肝炎患者血清中抗-线粒体M2亚型(AMA-M2)、抗-核包膜蛋白gp210(anti-gp210)、抗-可溶性酸性磷酸化核蛋白Sp100(anti-Sp100),结合自身免疫性肝病、脂肪性肝病、药物性肝病等疾病的诊断标准进行筛查分析。结果 PBC组AMA-M2、抗-gp210、抗-Sp100阳性率分别为97.67%(126/129)、41.86%(54/129)、27.91%(36/129),抗-gp210、抗-Sp100两者同时出现的阳性率为9.30%(12/129)。12例抗-gp210和抗Sp100抗体阳性的不明原因肝炎患者经肝组织活检后有3例诊断为PBC。PBC组有62.80%(81/129)的AMA-M2抗体滴度水平在1︰800以上,有13.95%(18/129)的AMA-M2抗体滴度水平为1︰25~100,有9.30%(12/129)的AMA-M2抗体滴度水平为1︰100~200。结论 AMA-M2阳性仍是诊断PBC的主要诊断指标,AMA-M2、抗-gp210、抗-Sp100的联合检测对PBC的诊断具有较高的应用价值,对筛查其他自身免疫肝病有较好的辅助作用。

Abstract: Objective To evaluate the diagnostic value of anti-mitochondrial antibodies-M2 subtype,  anti-gp210,  anti-Sp100  by  detecting  in  patients  with  primary  biliary cirrhosis (PBC). Methods Serum samples were detected for AMA-M2, anti-gp210 and anti-Sp100 by immunoblotting assay in 2000 patients with cryptogenic hepatitis, and other 15 healthy individuals were taken as control group. Patients were diagnosed as PBC (129 cases, 6.45%), AIH (205 cases, 10.25%), AIH-PBC overlap syndrome (15 cases, 0.75%), fatty liver (514 cases, 25.70%), drug-induced hepatitis (379 cases, 18.96%), and other unexplained hepatitis (758 cases, 37.90%).  Results The positive rates of these three antibodies were 97.67% (126/129), 41.86% (54/129), 27.91% (36/129), respectively. The simultaneous occurrence rate of anti-gp210 and anti-Sp100 was 9.30% (12/129).There were 12 cases with positive anti-gp210 and anti-Sp100 antibody, 3 of whom were diagnosed as PBC through liver puncture. In PBC group, patients with AMA-M2 antibody titer high than 1︰800 accounted for 62.80% (81/129), while the percents of patients with titers ranged from 1︰25 to 1︰100 and from 1︰100 to 1︰200 were 13.95% (18/129) and 30% (12/129), respectively. Conclusions AMA-M2 antibody is still the main marker for PBC diagnosis. The combined detection of AMA-M2 antibody, anti-gp210, anti-Sp100 in PBC have a higher value and play a good supporting role in screening other autoimmune liver diseases.

基金项目:
基金项目:国家自然科学基金资助面上项目(30973824)
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