抗延胡索酸水合酶抗体对自身免疫性肝炎和药物性肝损伤的鉴别诊断价值

韩莹; 陈杰; 单晶; 刘燕敏; 张小丹; 任美欣; 杜晓菲; 边新渠; 刘丹; 黄云丽; 黄春洋; 廖慧钰

doi:10.3969/j.issn.1001-5256.2019.06.029

抗延胡索酸水合酶抗体对自身免疫性肝炎和药物性肝损伤的鉴别诊断价值

DOI: 10.3969/j.issn.1001-5256.2019.06.029

基金项目:

佑安肝病艾滋病基金院内中青年人才孵育项目(YNKTTS20180109)；北京市属医院科研培育计划(PX2017010)；

详细信息

中图分类号: R575
计量
- 文章访问数: 1711
- HTML全文浏览量: 21
- PDF下载量: 269
- 被引次数: 0
出版历程
- 收稿日期: 2019-01-09
- 出版日期: 2019-06-20

Value of fumarate hydratase antibody in differential diagnosis of autoimmune hepatitis and drug-induced liver injury

Research funding:

摘要

摘要:
目的评价抗延胡索酸水合酶抗体（抗-FH）检测用于自身免疫性肝炎（AIH）和药物性肝损伤（DILI）鉴别诊断中的价值。方法选取2014年3月-2016年12月北京佑安医院住院的AIH患者105例为AIH组,DILI患者92例为DILI组,另选128例健康人为对照组,应用ELISA法检测血清中的抗-FH水平。计量资料两组间比较采用t检验或Mann-Whitney U检验,计数资料组间比较采用χ2检验或Fisher精确概率法。采用Kappa检验对抗-FH的诊断符合程度进行一致性分析。分析抗-FH在AIH诊断中的灵敏度、特异度、阳性预测值和阴性预测值。结果 AIH组患者的ANA阳性率明显高于DILI组（72. 4%vs 55. 4%,χ2=6. 147,P=0. 013）,IgG水平也明显高于DILI组[（18. 3±6. 1） g/L vs （15. 2±5. 4） g/L,t=-2. 566,P=0. 011]。在AIH患者中抗-FH的阳性率为36. 2%（38/67）,显著高于DILI组的6. 5%（6/92）和健康对照组的2. 3%（3/12...
- 延胡索酸水合酶 /
- 自身抗体 /
- 肝炎,自身免疫性 /
- 药物性肝损伤 /
- 诊断,鉴别
Abstract:
Objective To investigate the value of fumarate hydratase antibody (anti-FH) in the differential diagnosis of autoimmune hepatitis (AIH) and drug-induced liver injury (DILI) . Methods From March 2014 to December 2016, 105 patients with AIH who were hospitalized in Beijing You'an Hospital were enrolled as AIH group, and 92 patients with DILI were enrolled as DILI group. A total of 128 healthy individuals were enrolled as control group. ELISA was used to measure the serum level of anti-FH. The t-test or the Mann-Whitney U test was used for comparison of continuous data between two groups, and the chi-square test or the Fisher's exact test was used for comparison of categorical data between groups. A consistency analysis of diagnostic compliance of anti-FH based on the Kappa test. The sensitivity, specificity, positive predictive value, and negative predictive value of anti-FH in the diagnosis of AIH were analyzed. Results Compared with the DILI group, the AIH group had significantly higher positive rate of anti-nuclear antibody (72. 4% vs 55. 4%, χ2=6. 147, P = 0. 013) and level of IgG ( (18. 3 ± 6. 1) g/L vs (15. 2 ± 5. 4) g/L, t =-2. 566, P = 0. 011) ) . The AIH group had a significantly higher positive rate of anti-FH than the DILI group and the control group (36. 2% (38/67) vs 6. 5% (6/92) and 2. 3% (3/128) , χ2= 59. 959, P < 0. 001) . In the diagnosis of AIH, anti-FH had a sensitivity of 36. 2%, a specificity of 93. 5%, a positive predictive value of 86. 4%, and a negative predictive value of 93. 5%. Conclusion Serum anti-FH has a certain reference value in the differential diagnosis of AIH and DILI.
- fumigate hydratase /
- autoantibodies /
- hepatitis, autoimmune /
- drug-induced liver injury /
- diagnosis, differential

HTML全文

参考文献(11)

[1]European Association for the Study of the Liver.EASL Clinical Practice Guidelines:Autoimmune hepatitis[J].J Hepatol, 2015, 63 (4) :971-1004.

[2]Chinese Society of Hepatology, Chinese Medical Association;Chinese Society of Gastroenterology, Chinese Medical Association;Chinese Society of Infectious Diseases, Chinese Medical Association.Consensus on the diagnosis and management of autoimmune hepatitis (2015) [J].J Clin Hepatol, 2016, 32 (1) :9-22. (in Chinese) 中华医学会肝病学分会, 中华医学会消化病学分会, 中华医学会感染病学分会.自身免疫性肝炎诊断和治疗共识 (2015) [J].临床肝胆病杂志, 2016, 32 (1) :9-22.

[3]ALVAREZ F, BERG PA, BIANCHI FB, et al.International autoimmune hepatitis group report:Review of criteria for diagnosis of autoimmune hepatitis[J].J Hepatol, 1999, 31 (5) :929-938.

[4]BJORNSSON E, TALWALKAR J, TREEPRASERTSUK S, et al.Drug-induced autoimmune hepatitis:Clinical characteristics and prognosis[J].Hepatology, 2010, 51 (6) :2040-2048.

[5]LIAO HY, LI YL, YAN HP, et al.Establishment of an enzyme-linked immunosorbent assay for detecting of fumigate hydratase antibody and evaluation of its value in the diagnosis of auto immune hepatitis[J].Chin J Rheumatol, 2014, 18 (12) :819-822, after insert 1. (in Chinese) 廖慧钰, 李艳丽, 闫惠平, 等.抗延胡索酸水合酶抗体间接酶联免疫吸附试验法的建立及其对自身免疫性肝炎的诊断价值[J].中华风湿病学杂志, 2014, 18 (12) :819-822, 后插1.

[6]Drug-induced Liver Disease Study Group, Chinese Society of Hepatology, Chinese Medical Association.Guidelines for the management of drug-induced liver injury[J].J Clin Hepatol, 2015, 31 (11) :1752-1769. (in Chinese) 中华医学会肝病学分会药物性肝病学组.药物性肝损伤诊治指南[J].临床肝胆病杂志, 2015, 31 (11) :1752-1769.

[7]DANAN G, BENIEHOU C.Causality assessment of adverse reactions to drugs-A novel method based on the conclusions of international consensusmeetings:Application to drug-induced liver injuries[J].J Clin Epidemiol, 1993, 46 (11) :1323-1330.

[8]COUTO CA, BITTENCOURT PL, PORTA G, et al.Anti smooth muscle and antiactin antibodies are indirect markers of histological and biochemical activity of autoimmune hepatitis[J].Hepatology, 2014, 59 (2) :592-600.

[9]JIANG HL, QI YB, ZHANG R, et al.Detection rates of autoantibodies in patients with drug-induced liver injury and their clinical significance[J].J Clin Hepatol, 2018, 34 (1) :164-167. (in Chinese) 姜红丽, 祁亚宾, 张睿, 等.药物性肝损伤患者自身抗体的检出率及其临床意义[J].临床肝胆病杂志, 2018, 34 (1) :164-167.

[10]CHEN J, LIU YM, HUANG CY, et al.Clinical features of autoimmune hepatitis in children:An analysis of 10 cases[J].JClin Hepatol, 2018, 34 (10) :2164-2168. (in Chinese) 陈杰, 刘燕敏, 黄春洋, 等.儿童自身免疫性肝炎10例临床特征分析[J].临床肝胆病杂志, 2018, 34 (10) :2164-2168.

[11]XIA Q, LU F, YAN HP, et al.Autoantibody profiling of China patients with autoimmune hepatitis using immunoproteomic analysis[J].J Proteome Res, 2008, 7 (5) :1963-1970.

施引文献

资源附件(0)

访问统计