目的 探讨原发性胆汁性胆管炎(primary biliary cholangitis,PBC)患者血清中免疫球蛋白G(immunoglobulin G,IgG)亚型的分布特征.方法 选取2018年5月至2019年3月首都医科大学附属北京佑安医院收治的28例PBC患者、29例自身免疫性肝炎(autoimmune hepatitis,AIH)患者及同期30名健康体检者.散射比浊法检测血清IgG1、IgG2、IgG3、IgG4水平;分析IgG亚型水平及IgG亚型占总IgG水平百分比的分布特征.结果 IgG1、IgG1/IgG、IgG3、IgG3/IgG在3组中的分布差异均有统计学意义(P＜0.05),其中AIH组以IgG1、IgG1/IgG升高为特点,PBC组以IgG3、IgG3/IgG升高为特点.PBC组的IgG3与IgM水平呈显著正相关(r=0.709,P＜0.001).PBC患者中IgG3水平正常组与IgG3升高组抗线粒体抗体(AMA)的分布差异有统计学意义(x2=6.910,P=0.030),IgG3升高组的AMA-M2显著高于IgG3正常组[662.4(418.8,794.4) RU/ml比199.5(25.0, 308.9)RU/ml,Z=30.000,P=0.003].结论 PBC患者的IgG水平显著升高,且IgG抗体亚型以IgG3升高为主,IgG3升高可能与高滴度AMA和AMA-M2抗体有关.

目的 比较三种PIVKA-Ⅱ检测试剂的临床诊断效能,为检测机构选择提供参考依据.方法 收集健康对照组、慢性乙型肝炎组(慢乙肝)、肝硬化组和肝癌组四组临床血清样本,分别用三种不同试剂进行PIVKA-Ⅱ检测,对检测结果进行一致性、分布情况、诊断效能分析.结果 共收集217例临床血清样本,其中健康对照组33例、慢乙肝组33例、肝硬化组86例和肝癌组65例,各组男女比例差异无统计学意义(P＞0.05).三种试剂中,Abbott和Fuji检测结果具有较好的一致性(R2=0.84,P＜0.05).Roche与Abbott、Fuji的离群值多分布于肝癌组样本,且为PIVKA-Ⅱ高值样本.在肝癌诊断中,ROC分析显示Abbott、Fuji和Roche的AUC分别为0.882、0.878、0.857,最佳临界值分别为56.67 mAU/ml、68.00 mAU/ml、26.41 ng/ml.结论 三种试剂均具有良好的临床诊断效能,其中Abbott和Fuji具有较好的一致性.Roche与Abbott、Fuji的离群值多分布于肝癌高值样本.

Due to the absence of specific symptoms and low survival rate, efficient biomarkers for hepatocellular carcinoma (HCC) diagnosis are urgently required. The purpose of this study was to evaluate the diagnostic performance of protein induced by vitamin K absence or antagonist‐II (PIVKA‐II) and to determine the optimal cutoff values for HBV infection‐related HCC.

Viral and alcoholic liver disease, drug induced liver disease (DILD), primary biliary cirrhosis (PBC) and autoimmune hepatitis (AIH) are among the most common liver diseases observed in clinical practice. These diseases lack unique clinical characteristics at the beginning of pathogenesis, which renders specific diagnosis difficult. Immunoglobulin G (IgG) subclasses are the main isoform of antibodies that can be found in the serum that serve important protective roles in immunity. The present study aimed to investigate the serum IgG subclass distribution in patients with the five common liver diseases aforementioned. The present study retrospectively recorded and analyzed the serum IgG subclass levels of different patients, who were grouped according to their clinical diagnosis. Serum IgG subclass levels were measured using immunonephelometric assays. IgG3 levels were found to be significantly increased whereas IgG4 levels were significantly decreased in patients with PBC. In patients with AIH, IgG1 levels were significantly increased. By contrast, IgG1/IgG level ratios in patients with viral liver disease were significantly increased. No clear pattern in the distribution characteristics of IgG subclasses could be observed in cohorts with alcoholic liver disease and DILD in the present study. Additionally, model for end-stage liver disease scores regarding IgG1 in patients with AIH shared a synergistic relationship. Anti-mitochondrial antibody subtype M2 (AMA-M2) and IgG3 in patients with PBC demonstrated a synergistic relationship. These results suggested that IgG subclasses may be used as biomarkers to further the understanding of liver disease, which could allow for early diagnosis.

Objective To investigate the diagnostic value of serum FER, AFP and AFP-L3 alone or in combination for diagnosis of primary hepatic carcinoma( PHC).Methods This was a case-control study. Serum FER, AFP and AFP-L3 were determined in 212 patients with PHC ( StageⅠ45 cases, StageⅡ78 cases, StageⅢ81 cases, StageⅣ8 cases) , 127 patients with cirrhosis, 101 patients with chronic hepatitis and 98 controls in the Beijing Youan Hospital affiliated to Capital Medical University from January 2014 to December 2014.Levels of FER, AFP and AFP-L3 were measured by chemiluminescence, while serum samples were pre-treatment with affinity adsorption before AFP-L3 detection.FER, AFP and AFP-L3 levels were analyzed using the nonparametric Wilcoxon test among all groups.Diagnostic performance were analyzed among the groups with the three biomarkers independently and combined.Logistic regression, plotted ROC curve and calculated the area under ROC curve ( AUC) were applied to assess the diagnostic value of each index.Results Serum concentration of FER in PHC, cirrhosis, chronic hepatitis groups and healthy controls were 308.45 ( 148.98 -662.80 ) , 151.70 ( 51.44 -507.40 ) , 298.20 ( 157.30 -701.80 ) , 113.50( 54.98-221.38) μg/L, respectively.The concentration of AFP were 48.50(5.25 -748.40), 3.91(1.80-17.53), 4.76 (2.29-30.56), 2.57 (0.93-3.68) μg/L in each group.The serum levels of AFP-L3 in each group were 4.75(0.61-127.95), 0.61 (0.61-2.50), 0.61 (0.61-2.85), 0.61 (0.61-0.61) μg/L.The concentration of FER, AFP and AFP-L3 differs statistically in PHC, cirrhosis, chronic hepatitis group and healthy controls (χ2 =67.66,146.31,119.02,P<0.001).The content of serum FER, AFP and AFP-L3 increased gradually as the stage level aggravating ( StageⅠ-Ⅳ) , there was significant differences among groups (χ2 =21.63,22.68,21.98, P<0.001) .When using one serum marker, FER had the highest sensitivity (75.00%) , while AFP-L3 had the highest specificity (82.52%). While using two serum markers, FER/AFP had the highest sensitivity (89.15%) , FER+AFP-L3 and AFP+AFP-L3 had a higher specificity (86.20%).The combined detection of FER/AFP/AFP-L3 improved the sensitivity of the test to 89.15%, while FER+AFP+AFP-L3 had a specificity of 86.50%.The AUC of combination of FER, AFP and AFP-L3 was 0.803 ±0.019 (95% CI:0.765-0.841), which was higher than the AUC of either FER(0.748 ±0.022,95% CI:0.705-0.790, Z=4.67,P<0.001) and AFP-L3 (0.726 ±0.024,95% CI: 0.679 -0.772, Z=3.64,P<0.001).However, there was no significant difference in AUC between AFP alone ( 0.776 ±0.021, 95% CI: 0.735 -0.818 ) and the combined detection ( Z=1.34, P=0.18 ) .Conclusions FER was a potential marker for PHC diagnosis.The combination of FER, AFP and AFP-L3 has higher value of clinical applications than one of them independently.