Clinical Features And Clinical Significance Of Autoantibody Spectrum, Serum Cytokines And Peripheral T Lymphocyte Subsets In Chinese Patients With Primary Biliary Cirrhosis

Objective To study the clinical features and clinical significance of autoantibody spectrum, serum cytokines and peripheral T Lymphocyte subsets in Chinese patients with primary biliary cirrhosis.Methods Clinical data of 32 patients with PBC were reviewed. In Comparision with that of 20 patients with chronic hepatitis B and 20 healthy blood donors, 32 patients with PBC were examined for antinuclear antibody(ANA), anti-smooth muscle antibody (SMA), antimitochondrial antibody(AMA), antibody to liver/kidney microsome type 1(anti-LKM1) and perinuclear antineutrophil cytoplasmic antibody(pANCA) using immunofluorescence (IFA). Anti-LKM1,antibody to liver cytosol type 1(anti-LCl),antibody to soluble liver antigen/liver -pancreas(anti-SLA/LP) and subtype 2 of AMA(M-2) were detected by immune blotting. Serum cytokines,including IL-2, IFN- Y ,IL-4, IL-10 and TNF- α were detected by enzyme-linked immune absorbent assay(ELISA). S-P assay were used to detect T lymphocyte subsets in peripheral blood.Results Among the 32 patients with PBC, 30 patients were female and the gender ratio of female to male is 15:1. The average age at diagnosis was 43.32 + 10.45 year old, ranging from 25 to 61years. The most frequent clinical manifestations were jaundice(40.6%), fatigue(18.8%), pruritus(28.1 %).Complications mainly included: rheumatoid arthritis in 2 cases, autoimmune hemolytic in 2 cases, autoimmune hepatitis in 2 cases, diabetes mellitus in 2 cases,and sicca syndrome in 5 cases. Serum gamma glutamyl transpeptidase(GGT) and alkaline phosphatase(ALP) levels were dramatically elevated in all the patients with PBC (Median was 750.0 U/L and 481.0 U/L, respectively). The positive rate of SMA, anti-LKMl, anti-LC1, anti-SLA/LP and pANCA were low in all the 3 groups and there were no significant difference between different groups(p>0.05). The positive rate of ANA, AMA and M-2 in patients with PBC were 37.5%, 96.8% and 96.8% respectively and the positive rate were significantly high than that in HBV and healthy group. In contrast, there were no difference between HBV and healthy group in the above positive rate. In PBC patients, AMA titre ranged from 1:320 to 1:10000 and the mediangeometric titre of AMA was 1: 686.3. In other two groups, the AMA titre ranged from 1:100 to 1:320 and the median geometric titre of AMA was 1:126.3. The ANA median geometric titre of PBC was 1: 427.0, which was much higher than that of non-PBC( 1:262.2). Autoimmune overlap syndrome was found in 2 patients (PBC/AIH)with PBC. However, fewer autoantibodies to liver antigens were found in PBC and non-PBC. Compared to the control group with PBC in the study of T lymphcyte subset, It was found in PBC (l)the number of CD4+ T lymphocyte, CD4+/CD8+ ratio and the levels of IL-2, IFN- y and TNF-α were significantly increased (p<0.01) ,(2) The level of IL-10 was slightly increased (p<0.05),(3) CD8+ T cell was significantly decreased(p<0.01),(4) There was no difference at the level of IL-4 between PBC and healthly person (p>0.05) .Conclusion PBC is mostly found in milddle-aged women. The main clinical features are jaundice, fatigue and pruritus, and usaually companied with dramatically elevated alkaline phosphatase and glutamyl transpeptidase. The complications in other system are easely found in patients with PBC. The positive rate of AMA(M-2) and ANA in patients with PBC are significantly higher than in patients with viral hepatitis or healthy people. Meanwhile, the titre of AMA and ANA are very high. The detection for AMA and subtype 2 of AMA are helpful for diagnosis of primary biliary cirrhosis. CD4+ T lymphocytes and Th1 cytokines were predominant in peripheral blood in the patients...