抗-SLA/LP在自身免疫性肝炎的诊断、分型及病情评估中的应用价值
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摘要
目的:探讨抗-SLA/LP在自身免疫性肝炎的诊断、分型及病情评估中的应用价值。方法:选择2014年1月～2018年1月在我院诊治的自身免疫性肝炎患者82例进行回顾性分析,所有患者经组织学检查、临床症状及生化指标等综合诊断为自身免疫性肝炎,抗-SLA/LP阳性16例、抗-SLA/LP阴性66例,AIH-Ⅰ型51例、AIH-Ⅱ型15例、AIH-Ⅲ型16例。分析和比较抗-SLA/LP阴性和阳性患者的一般临床资料,抗-SLA/LP诊断AIH-Ⅲ型的灵敏度,比较抗-SLA/LP不同强度患者的临床和免疫功能相关指标。结果:抗-SLA/LP阴性和阳性患者的年龄、病程、ANA和AMA检出率无显著性差异,但抗-SLA/LP阳性患者的SMA检出率为0.00%,与抗-SLA/LP阴性患者相比具有统计学差异(P<0.05);抗-SLA/LP诊断AIH-Ⅲ型的灵敏度为100%,准确度为100%;抗-SLA/LP中高强度组患者的PTA和β2-微球蛋白水平均显著高于低强度阳性组(P<0.05),两组患者的免疫指标比较均无显著性差异(P>0.05)。结论:抗-SLA/LP对AIH-Ⅲ型患者的诊断具有高度的灵敏度和准确性,且抗-SLA/LP阳性强度可在一定程度上反映患者肝脏功能,对患者病情的评估具有一定的意义。
Objective: To explore the clinical value of anti-SLA/LP for the diagnosis, classification and evaluation of autoimmune hepatitis(AIH). Methods: 82 patients with AIH admitted in our hospital from January 2014 to January 2014 were retrospectively analyzed. All THE patients were diagnosed by histological examination, clinical symptoms and biochemical indexes. Anti-SLA/LP(+)were found in 16 cases, anti-SLA/LP(-) were found in 66 cases. Among them, there were 51 cases of AIH-Ⅰ, 15 cases of AIH-Ⅱ and 16 cases of AIH-Ⅲ. The clinical data of patients with negative and positive anti-SLA/LP, the sensitivity and accuracy of anti-SLA/LP for the diagnosis of AIH-Ⅲ, the clinical and related parameters of immune function in patients with different degree of anti-SLA/LP were analyzed. Results: There was no significant difference in the age, course, ANA and AMA detection rate between two groups. The detection rate of SMA was 0.00% in anti-SLA/LP positive patients, there were statistical differences compared with the anti-SLA/LP negative patients(P<0.05). The sensitivity and accuracy of anti-SLA/LP for the diagnosis of AIH-Ⅲ were 100% respectively. Both PTA and β2-microglobulin levels in the high-intensity positive group were significantly higher than those in the low-intensity positive group(P<0.05), and there was no significant difference between the other clinical indicators and immune indicators between high-intensity and low-intensity positive patients(P<0.05). Conclusions: Anti-SLA/LP had high sensitivity and accuracy for the diagnosis of patients with AIH-Ⅲ, and the SLA/LP positive intensity can reflect the liver function and had certain significance for the assessment of the disease condition.
Objective: To explore the clinical value of anti-SLA/LP for the diagnosis, classification and evaluation of autoimmune hepatitis(AIH). Methods: 82 patients with AIH admitted in our hospital from January 2014 to January 2014 were retrospectively analyzed. All THE patients were diagnosed by histological examination, clinical symptoms and biochemical indexes. Anti-SLA/LP(+)were found in 16 cases, anti-SLA/LP(-) were found in 66 cases. Among them, there were 51 cases of AIH-Ⅰ, 15 cases of AIH-Ⅱ and 16 cases of AIH-Ⅲ. The clinical data of patients with negative and positive anti-SLA/LP, the sensitivity and accuracy of anti-SLA/LP for the diagnosis of AIH-Ⅲ, the clinical and related parameters of immune function in patients with different degree of anti-SLA/LP were analyzed. Results: There was no significant difference in the age, course, ANA and AMA detection rate between two groups. The detection rate of SMA was 0.00% in anti-SLA/LP positive patients, there were statistical differences compared with the anti-SLA/LP negative patients(P<0.05). The sensitivity and accuracy of anti-SLA/LP for the diagnosis of AIH-Ⅲ were 100% respectively. Both PTA and β2-microglobulin levels in the high-intensity positive group were significantly higher than those in the low-intensity positive group(P<0.05), and there was no significant difference between the other clinical indicators and immune indicators between high-intensity and low-intensity positive patients(P<0.05). Conclusions: Anti-SLA/LP had high sensitivity and accuracy for the diagnosis of patients with AIH-Ⅲ, and the SLA/LP positive intensity can reflect the liver function and had certain significance for the assessment of the disease condition.
引文
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[25]Villalta D,Girolami E,Alessio M G,et al.Autoantibody Profiling in a Cohort of Pediatric and Adult Patients With Autoimmune Hepatitis[J].Journal of Clinical Laboratory Analysis,2016,30(1):41-46
[26]Rathor N,Khillan V,Sarin S K.Strongyloides stercoralis hyperinfection in patient with autoimmune hepatitis and purpura fulminans[J].Indian Journal of Critical Care Medicine:Peer-reviewed,Official Publication of Indian Society of Critical Care Medicine,2016,20(1):52-54
[27]Renand A P,Judor J P,AubléH,et al.Exhaustive blood immune phenotype of patients with autoimmune hepatitis[J].Journal of Hepatology,2017,66(1):S367-S368
[28]Ferreira M,Gon?alves C,Nobre S,et al.Diagnosis of autoimmune sclerosing cholangitis in children with autoimmune hepatitis[J].Journal of Hepatology,2017,66(1):S360
[29]Nakanuma Y,Ishizu Y,Zen Y,et al.Histopathology of Ig G4-Related Autoimmune Hepatitis and Ig G4-Related Hepatopathy in Ig G4-Related Disease[J].Seminars in Liver Disease,2016,36(03):229-241
[30]Duc P H,Kido T,Dung M H,et al.A 28-year observational study of urinary cadmium andβ2-microglobulin concentrations in inhabitants in cadmium-polluted areas in Japan[J].Journal of Applied Toxicology,2016,36(12):1622-1628
[2]Hoeroldt B S,Gleeson D,Shephard K,et al.PTU-077 Increased Long-Term Cancer Risk in Autoimmune Hepatitis(AIH):Relation to Immunosuppressive Drug Treatment[J].Journal of Hepatology,2016,64(2):S431-S432
[3]Liberal R,Boer Y S D,Andrade R J,et al.Expert clinical management of autoimmune hepatitis in the real world[J].Alimentary Pharmacology&Therapeutics,2017,45(5):723
[4]Than N N,Wiegard C,Weiler-Normann C,et al.Long-term follow-up of patients with difficult to treat type 1 autoimmune hepatitis on Tacrolimus therapy[J].Scandinavian Journal of Gastroenterology,2016,51(3):329-336
[5]Fan Y,Wang Q,Wang Z,et al.The Natural History and Prognosis of Primary Biliary Cirrhosis with Clinical Features of Autoimmune Hepatitis[J].Clinical Reviews in Allergy&Immunology,2016,50(1):114-123
[6]Luis Ibá?ez-Samaniego,Magdalena Salcedo,Vaquero J,et al.De novo autoimmune hepatitis after liver transplantation:A focus on glutathione S-transferase theta 1[J].Liver Transplantation,2017,23(1):75-85
[7]Puustinen L,Boyd S,Arkkila P,et al.Histologic surveillance after liver transplantation due to autoimmune hepatitis[J].Clinical Transplantation,2017,31(5):e12936
[8]Baharlou R,Kashani A F,Faraji F,et al.HLA-DRB1 alleles of susceptibility and protection in Iranians with autoimmune hepatitis[J].Human Immunology,2016,77(4):330-335
[9]Krishnamoorthy T L,Miezynskakurtycz J,Hodson J,et al.Long-term corticosteroid use after liver transplantation for autoimmune hepatitis is safe and associated with a lower incidence of recurrent disease[J]Liver Transplantation,2016,22(1):34-41
[10]Puustinen L,Boyd S,Mustonen H,et al.Prognostic value of clinical variables and liver histology for development of fibrosis and cirrhosis in autoimmune hepatitis[J].Scandinavian Journal of Gastroenterology,2017,52(3):321-327
[11]Jensen P,Egeberg A,Gislason G,et al.Increased risk of autoimmune hepatitis in patients with psoriasis:a Danish nationwide cohort study[J].Journal of Investigative Dermatology,2016,136(7):1515-1517
[12]Al T H,Hanouneh M A,Hanouneh I,et al.The use of tacrolimus in refractory autoimmune hepatitis in children and adults:a single center experience[J].Scandinavian Journal of Gastroenterology,2016,52(2)157-158
[13]Villalta D,Girolami E,Alessio M G,et al.Autoantibody Profiling in a Cohort of Pediatric and Adult Patients With Autoimmune Hepatitis[J].Journal of Clinical Laboratory Analysis,2016,30(1):41-46
[14]Toh B.Diagnostic autoantibodies for autoimmune liver diseases[J]Clin Transl Immunology,2017,6(5):e139
[15]Luo W,Ma L,Wen Q,et al.Concurrence of recurrent Wells syndrome and flares of systemic lupus erythematosus[J]Dermatologica Sinica,2016,34(1):56-57
[16]Edelstein M,Pimkin M,Palagin,et al.Prevalence and Molecular Epidemiology of CTX-M Extended-Spectrumβ-Lactamases Producing Escherichia coli and Klebsiella pneumoniae in Russian Hospital[J].Antimicrobial Agents and Chemotherapy,2003,47(12);3724-3732
[17]Peng X G,Li Y Y,Chen H T,et al.Evolution of correlation between Helicobacter pylori infection and autoimmune liver disease[J]Experimental&Therapeutic Medicine,2017,14(2):1487-1490
[18]?apiński T W,Rogalskap?ońska M,Parfieniukkowerda A,et al.The occurrence of autoantibodies in patients with chronic HCV infection including patients dialyzed and after kidney transplantation[J]Clinical&Experimental Hepatology,2016,2(4):161
[19]Toh B.Diagnostic autoantibodies for autoimmune liver diseases[J]Clin Transl Immunology,2017,6(5):e139
[20]Luo W,Ma L,Wen Q,et al.Concurrence of recurrent Wells syndrome and flares of systemic lupus erythematosus[J].Dermatologica Sinica,2016,34(1):56-57
[21]Muratori P,Lalanne C,Barbato E,et al.Features and Progression of Asymptomatic Autoimmune Hepatitis in Italy[J].Clinical Gastroenterology&Hepatology,2016,14(1):139-146
[22]Akande K O,Akere A,Otegbayo J A,et al.Accuracy of non-endoscopic predictors of oesophageal varices in liver cirrhosis using platelet count,splenic size and portal vein diameter[J].African Journal of Medicine&Medical Sciences,2016,45(3):243
[23]Jiao X,Kirsten K,Neumann A M,et al.Low-temperature leaf photosynthesis of a Miscanthusgermplasm collection correlates positively to shoot growth rate and specific leaf area[J].Annals of Botany,2016,117(7):1229-1239
[24]Weiler-Normann C,Marchenko N,Hartl J,et al.Klinische Signifikanz von SLA/LP Autoantik觟rpern in Patienten mit Prim覿r bili覿rer Cholangitis[J].Zeitschrift Für Gastroenterologie,2016,54(8)
[25]Villalta D,Girolami E,Alessio M G,et al.Autoantibody Profiling in a Cohort of Pediatric and Adult Patients With Autoimmune Hepatitis[J].Journal of Clinical Laboratory Analysis,2016,30(1):41-46
[26]Rathor N,Khillan V,Sarin S K.Strongyloides stercoralis hyperinfection in patient with autoimmune hepatitis and purpura fulminans[J].Indian Journal of Critical Care Medicine:Peer-reviewed,Official Publication of Indian Society of Critical Care Medicine,2016,20(1):52-54
[27]Renand A P,Judor J P,AubléH,et al.Exhaustive blood immune phenotype of patients with autoimmune hepatitis[J].Journal of Hepatology,2017,66(1):S367-S368
[28]Ferreira M,Gon?alves C,Nobre S,et al.Diagnosis of autoimmune sclerosing cholangitis in children with autoimmune hepatitis[J].Journal of Hepatology,2017,66(1):S360
[29]Nakanuma Y,Ishizu Y,Zen Y,et al.Histopathology of Ig G4-Related Autoimmune Hepatitis and Ig G4-Related Hepatopathy in Ig G4-Related Disease[J].Seminars in Liver Disease,2016,36(03):229-241
[30]Duc P H,Kido T,Dung M H,et al.A 28-year observational study of urinary cadmium andβ2-microglobulin concentrations in inhabitants in cadmium-polluted areas in Japan[J].Journal of Applied Toxicology,2016,36(12):1622-1628