Invernizzi Pietro, Lleo Ana, Podda Mauro
Division of Internal Medicine and Liver Unit, San Paolo Hospital School of Medicine, University of Milan, Milan, Italy.
Semin Liver Dis. 2007 May;27(2):161-72. doi: 10.1055/s-2007-979469.
Autoimmune liver diseases (ALD) are characterized by immune-mediated injury of bile ducts or hepatocytes, thus including cholangiopathies such as primary biliary cirrhosis (PBC), primary sclerosing cholangitis, and autoimmune hepatitis. Further, ALD variants manifesting with both hepatocellular and cholangiocellular damage are becoming more common. Serum autoantibodies, together with imaging and histology, are critical to the diagnostic process when ALD is suspected. Because an early diagnosis can influence prognosis, the development of sensitive and specific tests for serum autoantibodies should be a priority for researchers to ensure a more efficient noninvasive workup. Little prognostic value has been observed for any of the ALD serum hallmarks, and a vigorous effort to investigate new and old markers should therefore be undertaken in longitudinal studies as in the recent paradigm of PBC-specific antinuclear antibodies. We review herein the numerous ALD screening tests available in routine and specialized laboratories and comment on their significance in clinical practice.
自身免疫性肝病（ALD）的特征是胆管或肝细胞的免疫介导损伤，因此包括原发性胆汁性肝硬化（PBC）、原发性硬化性胆管炎和自身免疫性肝炎等胆管病。此外，表现为肝细胞和胆管细胞均受损的ALD变异型正变得越来越常见。当怀疑患有ALD时，血清自身抗体以及影像学和组织学检查对诊断过程至关重要。由于早期诊断会影响预后，因此开发敏感且特异的血清自身抗体检测方法应成为研究人员的首要任务，以确保更有效的非侵入性检查。尚未观察到任何ALD血清标志物具有显著的预后价值，因此应在纵向研究中大力开展对新旧标志物的研究，就像最近针对PBC特异性抗核抗体的研究模式那样。我们在此回顾了常规和专业实验室中可用的众多ALD筛查试验，并对它们在临床实践中的意义进行了评论。
