自身抗体在免疫介导性肝病中的临床应用和定义:全面概述。

The clinical usage and definition of autoantibodies in immune-mediated liver disease: A comprehensive overview.

机构信息

Epatocentro Ticino, Lugano, Switzerland.

Paediatric Liver, GI and Nutrition Centre, MowatLabs, King's College Hospital, Denmark Hill, London, SE5 9RS, UK.

出版信息

J Autoimmun. 2018 Dec;95:144-158. doi: 10.1016/j.jaut.2018.10.004. Epub 2018 Oct 23.

Abstract

Autoimmune serology is key to the diagnosis and management of autoimmune liver diseases. Its correct use in clinical practice requires a basic knowledge of the laboratory techniques used for autoantibody detection. Indirect immunofluorescence (IIF) on triple rodent tissue is still the gold standard screening procedure for liver-relevant autoantibodies, while HEp2 cells and human ethanol-fixed neutrophils are used as substrates to characterize nuclear reactivities and to detect anti-neutrophil cytoplasm antibody, respectively. Assays based on purified or recombinant antigens are increasingly used, having the main advantage of being observer-independent and the disadvantage of detecting only autoantibodies whose antigenic target has been identified. The AIH-specific anti-soluble liver antigen antibody cannot be detected by IIF and a molecular-based assay should be used at the screening level. Since autoantibodies may be present in the context of viral hepatitides and other inflammatory liver diseases it is important to exclude these conditions before diagnosing autoimmune liver disease. Anti-nuclear antibody (ANA), most often with a homogeneous IIF pattern on HEp2 cells, characterizes type 1 autoimmune hepatitis (AIH), and is found in association with anti-smooth muscle antibody in about half of the cases. Two IIF ANA patterns are specific for primary biliary cholangitis, namely the rim-like/membranous pattern, and the multiple nuclear dots pattern. Anti-liver kidney microsomal antibody type 1 is the serological hallmark of type 2 AIH, often in association with anti-liver cytosol type 1 antibody. Atypical perinuclear anti-neutrophil antibody, referred to as perinuclear anti-neutrophil nuclear antibody, is frequently detected in primary sclerosing cholangitis, in AIH type 1 and in inflammatory bowel diseases. The anti-asiaglycoprotein receptor antibody is liver-specific but not disease-specific, and reliable commercial assays for its detection are lacking. Anti-mitochondrial antibody is the hallmark of primary biliary cholangitis (PBC), being disease-specific and present in about 95% of the PBC patients. Its incidental detection presages the future development of PBC.

摘要

自身免疫性血清学是诊断和管理自身免疫性肝病的关键。为了在临床实践中正确使用它,需要对用于检测自身抗体的实验室技术有基本的了解。间接免疫荧光法(IIF)在三鼠组织上仍然是肝相关自身抗体的金标准筛选程序,而 Hep2 细胞和人乙醇固定中性粒细胞分别用作底物来描述核反应性并检测抗中性粒细胞胞质抗体。基于纯化或重组抗原的测定方法越来越多地被使用,它们的主要优点是观察者独立,缺点是仅能检测到其抗原靶标已被识别的自身抗体。AIH 特异性抗可溶性肝抗原抗体不能通过 IIF 检测,应在筛选水平使用基于分子的检测方法。由于自身抗体可能存在于病毒性肝炎和其他炎症性肝病的背景下,因此在诊断自身免疫性肝病之前排除这些情况非常重要。抗核抗体(ANA),最常见的是在 Hep2 细胞上具有均匀的 IIF 模式,其特征是 1 型自身免疫性肝炎(AIH),并且在大约一半的病例中与抗平滑肌抗体相关。两种 IIF ANA 模式是原发性胆汁性胆管炎的特异性,即边缘/膜模式和多核点模式。抗肝-肾微粒体抗体 1 型是 2 型 AIH 的血清学标志,通常与抗肝胞质 1 型抗体相关。非典型核周抗中性粒细胞抗体,称为核周抗中性粒细胞核抗体,常被检测到在原发性硬化性胆管炎、1 型 AIH 和炎症性肠病中。抗-asialoglycoprotein 受体抗体是肝脏特异性的,但不是疾病特异性的,并且缺乏可靠的商业检测方法。抗线粒体抗体是原发性胆汁性胆管炎(PBC)的标志,是疾病特异性的,存在于大约 95%的 PBC 患者中。其偶然检测预示着 PBC 的未来发展。

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