Histologically proven AMA positive primary biliary cholangitis but normal serum alkaline phosphatase: Is alkaline phosphatase truly a surrogate marker?
Histologically proven AMA positive primary biliary cholangitis but normal serum alkaline phosphatase: Is alkaline phosphatase truly a surrogate marker?
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组织学证明 AMA 阳性原发性胆汁性胆管炎，但血清碱性磷酸酶正常：碱性磷酸酶真的是替代标志物吗？
DOI：
10.1016/j.jaut.2019.01.005
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发表时间：
2019-05-01
影响因子：
12.8
通讯作者：
Ma, Xiong
中科院分区：
文献类型：
--
作者：
Sun, Chunyan;Xiao, Xiao;Ma, Xiong
背景和目标：抗线粒体抗体（AMAs）是原发性胆管炎（PBC）的血清学标志，是人类免疫病理学中最具针对性和特异性的自身抗体。然而，发现AMA阳性且碱性磷酸酶（ALP）正常的临床意义仍然是个谜。方法：我们利用了2012年1月至2018年1月期间被确定为AMA阳性但ALP水平正常的169名连续门诊患者。67/169这些AMA阳性正常ALP patients.Results：在所有169例患者中，我们再次确认AMA，并进行抗gp 210和抗sp100，肝脏硬度（LSM）评估振动控制瞬态弹性成像（VCTE），腹部计算机断层扫描（CT）扫描，无论是磁共振成像（MRI）或超声。由两名公正的观察员审查肝活检。169例患者中87.6%为女性，平均年龄46岁，中位AMA滴度为1：320，血清IgM升高者占53.3%。重要的是，在肝活检患者中，55（82.1%）的67有不同程度的胆管炎活动，诊断PBC.Conclusion：在AMA阳性但ALP水平正常的患者中，超过80%与组织学经典PBC相关。这些数据强调了AMA阳性的重要性，即使ALP正常，也质疑ALP作为胆管炎唯一替代标志物的作用。
Background and aims: The most highly directed and specific autoantibody in human immunopathology is the serologic hallmark of primary biliary cholangitis (PBC), antimitochondrial antibodies (AMAs). However the clinical significance of finding a positive AMA, with normal alkaline phosphatase (ALP) remains enigmatic.Methods: We took advantage of 169 consecutive outpatients who were identified as having a positive AMA, but normal ALP levels between January 2012 and January 2018. A liver biopsy was performed on 67/169 of these AMA positive normal ALP patients.Results: In all 169 patients we reconfirmed the AMA and also performed anti-gp210 and anti-sp100, liver stiffness (LSM) assessed by vibration-controlled transient elastography (VCTE), an abdominal computed tomography (CT) scan, and either a magnetic resonance imaging (MRI) or ultrasound. The liver biopsies were reviewed by two unbiased observers. 87.6% of the 169 patients were females with a mean age of 46; the median AMA titer 1:320; an elevated serum IgM was found in 53.3%. Importantly, in patients with a liver biopsy, 55 ( 82.1%) out of 67 had varying degrees of cholangitis activity, diagnostic of PBC.Conclusion: In patients who were AMA-positive but had normal ALP levels, more than 80% were associated with histological classic PBC. These data emphasize the importance of a positive AMA, even with a normal ALP and also question the role of ALP as a sole surrogate marker of cholangitis.