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自身免疫性肝炎的血清学标志物

Author
Michael A Heneghan, MD, MMedSc, FRCPI
Section Editor
Sanjiv Chopra, MD, MACP
Deputy Editor
Anne C Travis, MD, MSc, FACG, AGAF
Translators
苏倩, 主治医师

引言

自身免疫性肝炎是一种表现为有免疫学特点和自身免疫学特点的慢性肝炎，这些特点一般包括存在循环自身抗体和高总血清丙种球蛋白[通常只限于免疫球蛋白G(immunoglobulin G,IgG)部分][1]。大部分病例对抗炎或免疫抑制治疗有反应。 (参见“自身免疫性肝炎：治疗”)

主要的循环自身抗体(尽管对该病没有特异性)包括1型疾病中的抗核抗体(antinuclear antibody,ANA)和抗平滑肌抗体(anti-smooth muscle antibody,ASMA)，以及2型自身免疫性肝炎中的抗肝肾微粒体抗体1型(anti-liver-kidney microsome-1 antibody,ALKM-1)和抗肝细胞质1型抗体(anti-liver cytosol antibody-1, ALC-1)[2]。

人们认为自身抗体不参与自身免疫性肝炎的发病机制，且不能预测该病的组织学严重程度或疗效[3]。它们的主要作用是识别自身免疫性肝炎患者，从而指明适当的治疗方法并为分类建立基础(表 1)。 (参见“自身免疫性肝炎的分类”)

自身免疫性肝炎中的其他循环自身抗体也可为无典型自身抗体患者的诊断提供帮助，这些患者可能曾被诊断为“自身抗体阴性的自身免疫性肝炎”或隐源性慢性肝炎。例如，一名缺乏病毒性肝炎血清学标志物，但存在抗可溶性肝/肝胰抗原(anti-soluble liver/liver pancreas antigen,anti-SLA/LP)抗体或非典型核周抗中性粒细胞胞质抗体(perinuclear antineutrophil cytoplasmic antibody, pANCA)[也被称为“抗中性粒细胞核抗体”(anti-neutrophil nuclear antibody, pANNA)]的慢性肝炎患者，表明存在自身免疫性肝炎。

患者可能表现为无循环自身抗体的自身免疫性肝炎(被称为“自身抗体阴性的自身免疫性肝炎”)。虽然这类患者不常见，但他们的病程和对治疗的反应似乎与自身抗体阳性患者的相同[4]。

               

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Literature review current through: 2017-06 . | This topic last updated: 2015-07-27.
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