原发性胆汁性胆管炎的临床特征、抗体及组织病理学诊断

肝脏 ›› 2022, Vol. 27 ›› Issue (5): 566-569.

原发性胆汁性胆管炎的临床特征、抗体及组织病理学诊断

成亚娇, 陆观珠, 王玉环, 包玉洁, 许洁, 袁小凌

200011 上海交通大学医学院附属第九人民医院感染科

收稿日期:2021-12-08 出版日期:2022-05-31 发布日期:2022-07-13
通讯作者: 袁小凌,Email:xiaolingyuan@hotmail.com
基金资助:
学科特色疾病生物样本库项目(YBKB201917)

An analysis for the diagnostic?significance of clinical manifestation, autoantibodies and liver pathology of 84 patients with primary biliary cholangitis

CHENG Ya-jiao, LU Guan-zhu, WANG Yu-huan, BAO Yu-jie, XU Jie, YUAN Xiao-ling

Department of Infectious Disease,Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China

Received:2021-12-08 Online:2022-05-31 Published:2022-07-13
Contact: YUAN Xiao-ling, Email: xiaolingyuan@hotmail.com

摘要/Abstract

摘要： 目的分析原发性胆汁性胆管炎(PBC)的临床特征、自身抗体及肝脏组织病理学的诊断意义。方法对84例诊断为PBC及PBC-AIH重叠综合征的患者的年龄、性别、临床特征、自身抗体检测结果及肝脏组织病理学检查结果进行分析。结果 84例患者中,男女比例为1∶4.6,年龄(55.5±11.1)岁。常见的临床症状中AMA-M2阳性患者皮肤瘙痒发生率(27.3%)高于AMA-M2阴性患者(3.4%),差异有统计学意义(χ²=6.990,P=0.008)。AMA-M2阳性率65.5%,gp210阳性率23.8%,Sp100阳性率16.7%。在52例行肝脏组织病理学检查的患者中,23例患者AMA-M2阳性同时肝脏组织病理学结果提示PBC,23例患者AMA-M2阴性但肝脏组织病理学结果提示PBC。与AMA-M2阳性患者(7.3%)相比,AMA-M2阴性组(24.1%)诊断为PBC III期的患者更多,差异有统计学意义(χ²=4.746,P=0.042)。结论 AMA阳性对PBC诊断具有很高的敏感性和特异性,但是我国AMA-M2阴性比例偏高,虽然结合Sp100和gp210可提高PBC的诊断率,但仍存在漏诊或延误诊断,应增加肝脏组织病理学检查,实现早诊断、早治疗,从而改善患者预后及生活质量的目的。

关键词: 原发性胆汁性胆管炎,自身抗体,抗线粒体抗体,肝脏组织病理学

Abstract: Objective To analyze the clinical features, autoantibodies and the diagnostic significance of liver histopathology of primary biliary cholangitis (PBC), in order to improve the understanding of this disease. Methods The clinical characteristics, results of autoantibody tests and liver histopathological examination of 84 patients diagnosed with PBC or PBC-AIH overlap syndrome were analyzed. Results Among the 84 patients, the male to female ratio was 1:4.6, and the average age was (55.54±11.10) years. Among the common clinical symptoms, the incidence of skin pruritus in AMA-M2-positive patients (27.3%) is higher than that in AMA-M2-negative patients (3.4%), with statistical difference (χ²=6.990, P=0.008). The results of autoantibody tests indicated that the positive rates of AMA-M2, p210 and Sp100 were 65.5%, 23.8%, and 16.7%, respectively. Among 52 patients who underwent liver biopsies, 23 each of AMA-M2 positive and AMA-M2 negative patients have histopathologically confirmed PBC. Compared with the AMA-M2 positive patients, the AMA-M2 negative patients had more cases with significant fibrosis (i.e., PBC stage III, 7.3% vs 24.1%, χ²=4.746, P=0.042). Conclusion AMA positive has high sensitivity and specificity for the diagnosis of PBC. However, AMA-M2 negative PBC is also common in Chinese patients. Although the combination of Sp100 and gp210 tests can improve the diagnostic rate of PBC patients, the diagnosis was still easy to be missed or delayed. Histopathological examination to achieve early diagnosis and treatment is also important for improving the patient's prognosis and life qualities.

Key words: Primary Biliary Cholangitis, Autoantibodies, Antimitochondrial antibody, Liver histopathology

成亚娇, 陆观珠, 王玉环, 包玉洁, 许洁, 袁小凌. 原发性胆汁性胆管炎的临床特征、抗体及组织病理学诊断[J]. 肝脏, 2022, 27(5): 566-569.

CHENG Ya-jiao, LU Guan-zhu, WANG Yu-huan, BAO Yu-jie, XU Jie, YUAN Xiao-ling. An analysis for the diagnostic?significance of clinical manifestation, autoantibodies and liver pathology of 84 patients with primary biliary cholangitis[J]. Chinese Hepatolgy, 2022, 27(5): 566-569.

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