摘要
目的 通过比较抗线粒体抗体（AMA）阴性的原发性胆汁性肝硬化（AMA PBC）、AMA阳性的原发性胆汁性肝硬化（AMA＋ PBC）和自身免疫性肝炎（AIH）的临床生物化学和病理学特点,寻找有助于诊断AMA PBC的血清学标志物.方法 收集2005年1月至2013年5月就诊的23例AMA-PBC患者、102例AMA＋ PBC患者和55例AIH患者.观察患者的临床表现.进行生物化学指标（包括TBil、DBil、ALT、AST、ALP、GGT、球蛋白）和免疫学指标[包括免疫球蛋白（Ig）G、IgM、IgA]检测.采用间接免疫荧光法检测抗核抗体、抗平滑肌抗体（SMA）、AMA.采用免疫印迹法检测抗可溶性酸性磷酸化核蛋白抗体和抗核膜糖蛋白抗体.非正态分布的计量资料、等级资料的比较采用非参数检验.以ROC曲线计算IgM诊断PBC的最佳临界值及其敏感度和特异度.采用四格表法计算抗核膜糖蛋白抗体和抗可溶性酸性磷酸化核蛋白抗体诊断PBC的敏感度和特异度.结果 AMA-PBC组疲劳和黄疸的发生率[39.1％（9/23）和43.5％（10/23）]均高于AIH组[16.4％（9/55）和14.5％（8/55）],差异均有统计学意义（x2=4.735和7.648,P均＜0.05）.AMA-PBC组的ALP、GGT水平高于AIH组,ALT、AST水平低于AIH组（Z=-4.577、-4.257, 2.820、-2.055;P均＜0.05）.AMA PBC组的IgM水平[417（270,610） mg/L]高于AIH组[97（69,195） mg/L],但低于AMA＋ PBC组[546（419,704） mg/L],差异均有统计学意义（Z=-4.362和-0.210,P均＜0.05）.AMA PBC组的IgG水平低于AIH组（Z=-2.202,P＜0.05）.AMA PBC组的抗核抗体、SMA的阳性率[95.7％（22/23）,8.7％（2/23）]分别高于AMA＋ PBC组[33.3％（34/102）,1.o％（1/102）],差异均有统计学意义（x2=29.474和4.769,P均＜0.05）.AMA PBC组的抗可溶性酸性磷酸化核蛋白抗体和抗核膜糖蛋白抗体的阳性率[分别为60.9％（14/23）和30.4％（7/23）]均高于AIH组[分别为2.0％（1/55）和0],差异均有统计学意义（x2=36.409和24.329,P均＜0.05�
Objective To compare clinical biochemical and pathological characters among antimitochondrial antibody-negative primary biliary cirrhosis （AMA PBC）,AMA positive PBC （AMA＋ PBC）and autoimmune hepatitis （AIH）,and try to find serum biomarkers in the diagnosis of AMA-PBC.Methods From January 2005 to May 2013,23 patients with AMA-PBC,102 patients with AMA＋ PBC and 55 patients with AIH were collected.Clinical features of patients were observed.Biochemical indexes （total bilirubin （TBil）,direct bilirubin （DBil）,alanine aminotransferase （ALT）,aspartate transaminase （AST）,alkaline phosphatase （ALP）,γ-glutamyltransferase （GGT） and globulin） were tested.Immunological indexes immunoglobulin （（Ig）G,IgM and IgA） were also measured.Antinuclear amibody,anti smooth muscle antibody （SMA） and AMA were detected by indirect immunofluorescence.Soluble acidic phosphorylation nucleoprotein antibody and anti-nuclear membrane glycoprotein antibody were detected by Western blotting.Non parameter test was for non normal distributed measurement data and grade data comparison.The cut off value,sensitivity and specificity of IgM in the diagnosis of PBC were calculated with receiver operating characteristic （ROC） curve.The sensitivity and specificity of soluble acidic phosphorylation nucleoprotein antibody and anti-nuclear membrane glycoprotein antibody in the diagnosis of PBC were analyzed with fourfold table.Results The rates of fatigue and jaundice of AMA-PBC group （39.1%,9/23 ; 43.5 %,10/23） were both higher than those of AIH group （16.4 %,9/55; 14.5 %,8/55）,and the differences were statistically significant （x2 =4.735 and 7.648,both P〈 0.05）.The levels of ALP and GGT of AMA PBC group were higher than those of AIH group,and the levels of ALT and AST were lower than those of AIH group （Z=-4.577,-4.257,-2.820 and -2.055,all P〈0.05）.The level of IgM of AMA PBC group （417（270,610） mg/L） was higher than that of AIH group （97（69,195） mg/L）,however lowe
出处
《中华消化杂志》
CAS
CSCD
北大核心
2015年第2期86-89,共4页
Chinese Journal of Digestion
基金
国家自然科学基金（81200282,81470834）
天津市卫生局科技攻关项目（12KG133）
关键词
抗线粒体抗体
肝硬化
胆汁性
肝炎
自身免疫性
sp100抗体
gp210抗体
免疫球蛋白M
Anti-mitochondrial antibody
Liver cirrhosis,biliary
Hepatitis,autoimmune
Immunoglobulin M
sp100 antibody
gp210 antibody
