Department of Medicine, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada.
Clin Gastroenterol Hepatol. 2009 Dec;7(12):1355-60. doi: 10.1016/j.cgh.2009.07.012. Epub 2009 Jul 22.
BACKGROUND & AIMS: It is challenging to diagnose patients with chronic cholestatic liver diseases when all the classic criteria are not fulfilled. We evaluated the performance of the recently developed MIT3-based enzyme-linked immunosorbent assay (ELISA), which detects antimitochondrial autoantibodies (AMAs), together with ELISAs for other autoimmune liver disease-related antibodies in patients with chronic cholestatic liver disease.
Sera from 281 patients with chronic cholestatic conditions, including primary biliary cirrhosis (PBC), primary sclerosing cholangitis, AMA-positive autoimmune hepatitis, and "undetermined cholangiopathy" were tested for the following PBC-associated autoantibodies: anti-gp210, anti-sp100, conventional anti-M2, anti-M2 (MIT3) IgG, anti-M2 (MIT3) IgA, as well as anti-centromere, anti-soluble liver antigen, and anti-chromatin.
Of 57 patients with PBC who were AMA-negative by conventional M2 ELISA, 14 were found to be AMA-positive by the MIT3-IgG assay. Furthermore, on the basis of the data from 3 tests (MIT3-IgG, gp210, and sp100), PBC was confirmed in 20 of 57 (35%) patients diagnosed with AMA-negative PBC. We confirmed that sp100 and gp210 antibodies were detected only in patients with PBC and AMA-positive autoimmune hepatitis, whereas gp210 was detected more frequently in patients known to have had a poor outcome. Of the 11 patients with an undetermined cholangiopathy, 3 (27%) tested positive for PBC with the MIT3-IgG assay. In contrast to previous findings, anti-centromere antibodies were not found to be associated with poor outcome in PBC.
ELISAs for AMAs and antinuclear antibodies are useful in diagnosis and prognosis of patients with features of PBC who lack conventional AMA and in patients with a cholangiopathy of undetermined etiology.
当并非所有经典标准都得到满足时，诊断患有慢性胆汁淤积性肝病的患者具有挑战性。我们评估了最近开发的基于 MIT3 的酶联免疫吸附测定法（ELISA）的性能，该测定法可检测抗线粒体自身抗体（AMA），并结合用于慢性胆汁淤积性肝病患者的其他自身免疫性肝病相关抗体的 ELISA。
对 281 例患有慢性胆汁淤积性疾病的患者的血清进行了检测，包括原发性胆汁性胆管炎（PBC）、原发性硬化性胆管炎、AMA 阳性自身免疫性肝炎和“未确定的胆管病”，用于以下 PBC 相关自身抗体的检测：抗 gp210、抗 sp100、常规抗 M2、抗 M2（MIT3）IgG、抗 M2（MIT3）IgA 以及抗着丝粒、抗可溶性肝抗原和抗染色质。
在 57 例经常规 M2 ELISA 检测为 AMA 阴性的 PBC 患者中，有 14 例经 MIT3-IgG 检测为 AMA 阳性。此外，基于 3 项检测（MIT3-IgG、gp210 和 sp100）的数据，在诊断为 AMA 阴性 PBC 的 57 例患者中的 20 例（35%）中确认了 PBC。我们确认 sp100 和 gp210 抗体仅在 PBC 和 AMA 阳性自身免疫性肝炎患者中被检测到，而 gp210 在已知预后不良的患者中被更频繁地检测到。在 11 例未确定的胆管病患者中，有 3 例（27%）经 MIT3-IgG 检测呈 PBC 阳性。与之前的发现相反，抗着丝粒抗体与 PBC 的不良预后无关。
AMA 和抗核抗体的 ELISA 在缺乏常规 AMA 且病因不明的胆管病患者中具有特征性 PBC 的患者的诊断和预后中很有用。
