探讨并分析不同肝脏疾病中 HEp 2 间接免疫荧光效价和模式。

Investigation and analysis of HEp 2 indirect immunofluorescence titers and patterns in various liver diseases.

机构信息

Department of Rheumatology, the Third Affiliated Hospital of Sun Yat-sen University, Guangdong Province, Guangzhou, China.

出版信息

Clin Rheumatol. 2020 Aug;39(8):2425-2432. doi: 10.1007/s10067-020-04950-7. Epub 2020 Feb 27.

DOI:10.1007/s10067-020-04950-7

PMID:32103375

Abstract

INTRODUCTION

Antinuclear antibody (ANA) testing using indirect immunofluorescence assay (IIFA) is a common and economical method which contributes to detect systemic autoimmune diseases (SARD) and autoimmune liver diseases (AILD). The primary aim of our study was to investigate ANA positivity and their patterns in multiple liver diseases, including primary biliary cirrhosis (PBC), autoimmune hepatitis (AIH), hepatitis B virus infection (HBV), hepatitis C virus infection (HCV), and hepatic carcinoma (HCC). Besides, we also compared the ANA titers and patterns in patients with liver disease, SARD, and healthy controls (HC).

METHODS

A total of 2537 patients with SARD, 137 PBC cases, 57 AIH cases, 3420 HBV cases, 769 HCV cases, 268 HCC cases, and 1073 HC were retrospectively assessed. The titers and patterns of ANA were detected with the IIFA method.

RESULTS

ANA positivity rate was considerably discernible between these diseases, which is 90.1% in SARD, 93.4% in PBC, 49.1% in AIH, 19.1% in HBV, 13.9% in HCV, and 23.5% in HCC. Moreover, only 4.9% of HCC cases, 2.5% of HBV patients, and 1.6% of HCV patients had an ANA titer ≥ 1:320. The mixed pattern which composed of at least two patterns majorly lied in PBC. AC-15 and AC-21 was frequently related to liver diseases; the former pattern was more frequently found in AIH (84.2%) and PBC (8.8%), and the latter pattern was easily seen in PBC (62.2%) and HCC (22.6%). The positive rate of ANA in HC was 12.2%, and its major pattern was AC-2.

CONCLUSIONS

There are differences in ANA positivity among patients with SARD and various liver diseases. Some mixed patterns may provide important evidence for the diagnosis of PBC. Clinicians should pay attention to ANA patterns and titer during the interpretation of this test. Key Points • Defining the clinical relevance of antinuclear antibody (ANA) using indirect immunofluorescence assay in the context of diseases can be an important tool for the clinician in the diagnostic work-up of patients with liver diseases. • The mixed pattern of ANA is majorly found in primary biliary cirrhosis (PBC). ANA patterns including AC-15 and AC-21 are frequently related to liver diseases. AC-15 is more often found in autoimmune hepatitis (AIH) (84.2%) and PBC (8.8%), and AC-21 is easily found in PBC (62.2%, and hepatic carcinoma (HCC) (22.6%). • ANA positivity can be seen in 19.1% of hepatitis B virus infection (HBV) cases, 13.9% of hepatitis C virus infection (HCV) cases, and 23.5% of HCC cases. Only 2.5% of HBV patients, 1.6% of HCV patients, and 4.9% of HCC cases have an ANA titer ≥ 1:320.

摘要

简介

使用间接免疫荧光法（IIFA）检测抗核抗体（ANA）是一种常见且经济的方法，有助于检测系统性自身免疫疾病（SARD）和自身免疫性肝病（AILD）。我们研究的主要目的是调查多种肝病患者的 ANA 阳性率及其模式，包括原发性胆汁性肝硬化（PBC）、自身免疫性肝炎（AIH）、乙型肝炎病毒感染（HBV）、丙型肝炎病毒感染（HCV）和肝细胞癌（HCC）。此外，我们还比较了肝病患者、SARD 患者和健康对照者（HC）的 ANA 滴度和模式。

方法

回顾性评估了 2537 例 SARD 患者、137 例 PBC 病例、57 例 AIH 病例、3420 例 HBV 病例、769 例 HCV 病例、268 例 HCC 病例和 1073 例 HC。采用 IIFA 法检测 ANA 的滴度和模式。

结果

这些疾病之间的 ANA 阳性率差异明显，SARD 为 90.1%，PBC 为 93.4%，AIH 为 49.1%，HBV 为 19.1%，HCV 为 13.9%，HCC 为 23.5%。此外，只有 4.9%的 HCC 病例、2.5%的 HBV 患者和 1.6%的 HCV 患者的 ANA 滴度≥1:320。混合模式主要由至少两种模式组成，主要见于 PBC。AC-15 和 AC-21 与肝脏疾病密切相关；前者模式在 AIH（84.2%）和 PBC（8.8%）中更为常见，后者模式在 PBC（62.2%）和 HCC（22.6%）中更为常见。HC 的 ANA 阳性率为 12.2%，其主要模式为 AC-2。