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抗核抗体及肝组织病理对男性自身免疫性肝病患者的诊断意义分析
Value of anti-nuclear antibody and liver pathology in diagnosis of male patients with autoimmune liver diseases
文章发布日期:2019年04月04日  来源:  作者:肖倩,谭善忠,赵天慧,等  点击次数:390次  下载次数:123次

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【摘要】:目的探讨抗核抗体(ANA)对于诊断男性自身免疫性肝病的意义及肝组织病理在自身免疫性肝病检查中的作用。方法 选取2016年12月-2018年6月于南京市第二医院就诊的不明原因肝病男性患者84例,其中ANA阳性36例,阴性48例。将2组患者的肝组织病理、实验室检查及诊断情况进行对比分析。正态分布的计量资料多组间比较采用单因素方差分析,进一步两两比较采用LSD-t检验;偏态分布的计量资料多组间比较采用Kruskal-Wallis H秩和检验,进一步两两比较采用Nemenyi检验。计数资料组间比较采用χ2检验。结果ANA阳性组中,自身免疫性肝炎5例,重叠综合征1例;ANA阴性组中自身免疫性肝炎5例,重叠综合征5例。2组确诊自身免疫性肝病的比例差异无统计学意义(16.7% vs 20.8%,χ2=0.23,P>0.05)。将所有患者分为自身免疫性肝炎组(n=10)、重叠综合征组(n=6)、药物性肝损伤组(n=17)及其他组(n=51),4组间IgG、球蛋白水平比较,差异均有统计学意义(F值分别为2.977、6.972,P值均<0.05)。10例自身免疫性肝炎患者均可见界面性肝炎;ANA阳性组淋巴-浆细胞浸润出现4例,ANA阴性组3例;ANA阳性组与阴性组肝细胞玫瑰花环样改变各2例;有2例患者可见淋巴细胞穿入;1例患者见多核巨肝细胞。6例重叠综合征患者主要病理学表现为中-重度界面性肝炎或碎屑样坏死及门静脉区域的炎性浸润,其中2例存在肝细胞玫瑰花环样改变,2例表现为小叶间胆管损伤,胆管周围淋巴细胞浸润/肉芽肿形成,继发肝纤维化。结论对于不明原因肝病男性人群,ANA是否阳性对自身免疫性肝病(自身免疫性肝炎和重叠综合征)的诊断意义不大,应结合肝组织病理学检查结果综合分析,以提高确诊率。
【Abstract】:ObjectiveTo investigate the value of anti-nuclear antibody (ANA) in the diagnosis of male patients with autoimmune liver diseases and the role of liver pathology in the examination of autoimmune liver diseases. MethodsA total of 84 male patients with unexplained liver diseases who visited Nanjing Second Hospital from December 2016 to June 2018 were enrolled, and among them, 36 had positive ANA and 48 had negative ANA. The two groups were compared in terms of liver pathology, laboratory examination, and diagnosis. A one-way analysis of variance was used for comparison of normally distributed continuous data between multiple groups, and the least significant difference t-test was used for further comparison between two groups. The Kruskal-Wallis H test was used for comparison of continuous data with skewed distribution between multiple groups, and the Nemenyi test was used for further comparison between two groups. The chi-square test was used for comparison of categorical data between groups. ResultsAmong the 36 male patients in the positive ANA group, 5 had autoimmune hepatitis and 1 had overlap syndrome; among the patients in the negative ANA group, 5 had autoimmune hepatitis and 5 had overlap syndrome. There was no significant difference between the two groups in the proportion of patients with a confirmed diagnosis of autoimmune liver diseases (16.7% vs 20.8%, χ2=0.23, P>0.05). All the patients were divided into autoimmune hepatitis group with 10 patients, overlap syndrome group with 6 patients, drug-induced liver injury group with 17 patients, and other group with 51 patients, and there were significant differences in immunoglobulin G and globulin between groups (F=2.977 and 6.972, P<0.05). Interface hepatitis was observed in all ten patients with autoimmune hepatitis. Four patients in the positive ANA group and three in the negative ANA group had lymphocyte-plasma cell infiltration. Rosette-like changes of hepatocytes were found in two patients each in the positive ANA group and the negative ANA group. Lymphocyte penetration was observed in two patients and multinucleated giant hepatocytes were seen in one patient. The six patients with overlap syndrome had the pathological manifestation of moderate to severe interface hepatitis or debris-like necrosis and inflammatory infiltration in the portal vein area; among these patients, two had rosette-like changes of hepatocytes, and two had interlobular bile duct injury, lymphocyte infiltration/granuloma formation around the bile duct, and secondary hepatic fibrosis. ConclusionPositive or negative ANA has little significance in the diagnosis of autoimmune liver diseases (autoimmune hepatitis and overlap syndrome) in ANA-positive male patients with unexplained liver diseases. Liver pathological results should be incorporated into the comprehensive analysis, which may help with the diagnosis of liver diseases.
【关键字】:肝疾病; 自身抗体; 病理状态, 体征和症状; 横断面研究
【Key words】:liver diseases; autoantibodies; pathological conditions, signs and symptoms; cross-sectional studies
【引证本文】:XIAO Q, TAN SZ, ZHAO TH, et al. Value of anti-nuclear antibody and liver pathology in diagnosis of male patients with autoimmune liver diseases[J]. J Clin Hepatol, 2019, 35(5): 1070-1073. (in Chinese)
肖倩, 谭善忠, 赵天慧, 等. 抗核抗体及肝组织病理对男性自身免疫性肝病患者的诊断意义分析[J]. 临床肝胆病杂志, 2019, 35(5): 1070-1073.

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