上海地区体检者中筛查 M2型抗线粒体抗体的阳性率分析

摘要

目的：通过分析成年体检者M2型抗线粒体抗体（ AMA-M2）的阳性率情况，评价AMA-M2对原发性胆汁性肝硬化（ PBC）早期筛查的价值。方法收集健康体检人群血清样本6658例，其中男3845例，女2813例，男女比例为1．37∶1，年龄（46±13）岁。采用酶联免疫吸附试验（ ELISA）定量检测AMA-M2，并与血清丙氨酸氨基转移酶（ ALT）、天门冬氨酸氨基转移酶（ AST）、碱性磷酸酶（ ALP）和γ-谷氨酰基转移酶（ GGT）检测结果同时分析。结果在6658名健康体检者中 AMA-M2阳性97例（1．46％），其中男性和女性分别为44例（1．14％）和53例（1．88％），男女之比为1∶1．2；≥46岁的女性AMA-M2阳性率高于＜46岁的女性（P＜0．01），97例AMA-M2阳性且无任何疾病包括PBC相关临床症状者中有8例伴ALP升高，GGT也升高。结论对健康体检者应高度重视AMA-M2与ALP／GGT甚至ALT与AST的关联分析，AMA-M2筛查是高危人群早期发现PBC的有效途径，按照美国肝脏病学会（ AASLD） PBC诊疗指南的诊断标准监测AMA-M2阳性体检者的AMA-M2和肝脏血清酶水平有助于提高PBC的早诊率。%Objective To investigate the early screening significance of M2 anti-mitochondrial antibodies(AMA-M2) for primary biliary cirrhosis(PBC) in physical examine, through analyzing the positive rate of AMA-M2.Methods Serum samples were collected from 6 658 healthy subjects(3 845 males and 2 813 females), and the sex ratio was 1.37∶1.Their age was 46 ±13.AMA-M2 was quantitatively determined by enzyme-linked immunosorbent assay(ELISA).Serum alanine aminotransferase(ALT), aspartate aminotransferase(AST), alkaline phosphatase(ALP) and gamma glutamyltransferase (GGT) were determined, and the results were analyzed cemparatively .Results AMA-M2 were detected in 97 of 6 658 healthy subjects(1.46%), including 44 males (1.14%) and 53 females(1.88%), and the sex ratio was 1∶1.2.AMA-M2 positive rate of females above 46 years old was higher than those below 46 years old (P<0.01).The 8 of 97 AMA-M2 positive cases without PBC clinical feature had increasing ALP and GGT .Conclusions Physical examination should pay attention to the correlation analysis of AMA-M2 with ALP/GGT and ALT with AST .AMA-M2 screening is an effective mean to high risk population in the early detection of PBC .According to American Association for the Study of Liver Disease ( AASLD) PBC liver disease diagnostic criteria , positive AMA-M2 and serum liver enzyme help with improving the early detection rate of PBC .