东埃塞俄比亚自身免疫性肝病相关自身抗体的高血清阳性率：咀嚼恰特草（Catha edulis）是否是一个触发因素？
High Seroprevalence of Autoantibodies Typical of Autoimmune Liver Disease in Eastern Ethiopia: Is Chewing of Khat (Catha edulis) a Triggering Factor?
机构信息
Regional Advisory Unit for Imported and Tropical Diseases, Oslo University Hospital Ullevål, Oslo, Norway.
Department of Paediatrics, Vestfold Hospital Trust, Tønsberg, Norway.
出版信息
Can J Gastroenterol Hepatol. 2018 Dec 23;2018:4980597. doi: 10.1155/2018/4980597. eCollection 2018.
BACKGROUND
Recent studies have identified chewing of khat () as an independent risk factor for liver injury; however, the pathogenetic mechanism remains poorly understood. Case series have found markers of autoimmune hepatitis in patients with khat-related liver disease, suggesting that khat chewing might trigger an autoimmune response. The aims of the present study were (i) to assess the prevalence of autoantibodies typical for autoimmune liver diseases in a healthy population in Ethiopia and (ii) to explore the hypothesis that khat usage triggers autoimmunity.
METHODS
Consenting adults (≥18 years) without known autoimmune disease or manifest liver disease were included. One-hundred-and-sixty-nine individuals with current khat use were compared to 104 individuals who never used khat. Seroprevalence of antinuclear (ANA), antismooth muscle (SMA), and antimitochondrial antibodies (AMA) were determined and compared between the groups using logistic regression models to adjust for age and sex.
RESULTS
Overall, 2.6% of the study subjects were positive for ANA, 15.4% for SMA, and 25.6% for AMA. When comparing khat users to nonusers, ANA was detected in 4.1% vs. 0% (p=0.047), SMA in 16.0% vs. 14.4% (p=0.730), and AMA in 24.9% vs. 26.9% (p=0.704). ANA was excluded from multivariable analysis since there was no seropositive in the reference group. After adjusting for sex and age, no significant association between khat use and SMA or AMA was found.
CONCLUSIONS
No association between khat usage and the seropresence of SMA or AMA was found, weakening the hypothesis that khat-related liver injury is mediated through autoimmune mechanisms. However, the seroprevalences of AMA and SMA were strikingly high in this Ethiopian population compared to global estimates, suggesting that diagnostic algorithms for autoimmune liver diseases developed in Europe and North America might lead to misdiagnosis of patients on the African continent.
背景
最近的研究已经确定咀嚼恰特草（）是肝损伤的一个独立危险因素；然而，其发病机制仍知之甚少。病例系列研究发现，在与恰特草相关的肝病患者中存在自身免疫性肝炎的标志物，这表明咀嚼恰特草可能引发自身免疫反应。本研究的目的是：（i）评估埃塞俄比亚健康人群中常见的自身免疫性肝病的自身抗体流行率；（ii）探讨恰特草使用引发自身免疫的假说。
方法
纳入年龄在 18 岁及以上且无已知自身免疫性疾病或明显肝脏疾病的成年人。将 169 名目前使用恰特草的个体与 104 名从未使用过恰特草的个体进行比较。使用逻辑回归模型确定和比较两组人群的抗核抗体（ANA）、抗平滑肌抗体（SMA）和抗线粒体抗体（AMA）的血清阳性率，并调整年龄和性别。
结果
总的来说，研究对象中有 2.6%的人 ANA 阳性，15.4%的人 SMA 阳性，25.6%的人 AMA 阳性。与非使用者相比，恰特草使用者的 ANA 阳性率为 4.1%，而非使用者为 0%（p=0.047），SMA 阳性率为 16.0%，而非使用者为 14.4%（p=0.730），AMA 阳性率为 24.9%，而非使用者为 26.9%（p=0.704）。由于参考组中没有血清阳性者，因此将 ANA 排除在多变量分析之外。调整性别和年龄后，恰特草使用与 SMA 或 AMA 之间无显著关联。
结论
本研究未发现恰特草使用与 SMA 或 AMA 血清阳性之间存在关联，这削弱了恰特草相关肝损伤是通过自身免疫机制介导的假说。然而，与全球估计值相比，埃塞俄比亚人群中 AMA 和 SMA 的血清阳性率非常高，这表明在欧洲和北美开发的自身免疫性肝病诊断算法可能导致非洲大陆患者的误诊。
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