| Objectives:Primary biliary cholangitis(PBC)is a chronic progressive cholestatic liver disease mediated by autoimmune response,which etiology and pathogenesis have not been elucidated.Then early diagnosis of PBC is difficult.Anti-centromere antibody(ACA)is one of the subtypes of antinuclear antibody(ANA),which has a certain positive rate in PBC and is of great significance for the auxiliary diagnosis of PBC.The aim of this study is to explore the clinical significance of ACA in PBC,and provide a clinical basis for the role of ACA in the diagnosis of PBC.Methods:The clinical data of 334 PBC patients who were admitted to the Department of Rheumatology and Immunology of the Affiliated Hospital of Qingdao University from January 2012 to December 2020 were collected.The serum ACA of PBC patients was measured by indirect immunofluorescence(IF)to determine the differences of ACA in PBC patients.The differences in general data,clinical manifestations,blood routine results,imaging examination and pathological staging between ACA-positive patients and ACA-negative ones were compared.The ACA-positive patients without liver involvement were also included to explore the differences in biochemical indicators and immunological indicators among the three groups.Results:1.Among 334 PBC patients,102(30.54%)cases were ACA-positive and 232(69.46%)cases were ACA-negative.In terms of general information,there were differences between the two groups in female patients’ prevalence rate,age of onset and incidence of fever symptoms.The incidence of female patients(97.06% vs 90.95%)and febrile symptom(19.61% vs 8.62%)in ACA-positive group were significantly higher than those in ACA-negative group,and the age of onset(63.46±12.10 vs 57.39±13.86)was larger than that in ACA-negative group,the difference was statistically significant(P< 0.05).2.In terms of biochemical data,the median level of serum alanine aminotransferase(ALT)in the PBC group with ACA-negative was higher than that in the ACA-positive group without liver involvement(38.65 and 18.95 U/l),and the median level of serum Alt in the PBC group with ACA-positive was higher than that in the ACA-positive group without liver involvement(28.60 and 18.95 U/l),the difference was statistically significant(P < 0.05).As for serum aspartate aminotransferase(AST),the PBC group with ACA-negative(38.60 and 18.95 U/l)and the PBC group with ACA-positive were higher than those with ACA-positive without liver involvement(34.00 and 18.95 U/l),and the differences were statistically significant(P < 0.05).The median levels of serum alkaline phosphatase(ALP)(124.65,114.50 and 69.25 U/l)and serum direct bilirubin(DBIL)(6.57,6.05 and 3.51 mmol/l)were compared among the three groups.ACApositive PBC group was higher than ACA-negative PBC group and ACA-positive group without liver involvement,and the difference was statistically significant(P < 0.05).The median levels of serum red blood cell count(RBC)in the three groups were 3.91,3.89 and 4.53*10^12/l,respectively.ACA-positive group without liver expression was higher than ACA-positive PBC group,ACA-negative PBC group,the difference was statistically significant(P < 0.05).3.The positive rates of AMA and AMA-M2 in PBC group with ACA-negative were higher than those in non-PBC group(78.45% vs.7.14%,74.14% vs.0),and those in PBC group with ACA-positive were higher than those in non-PBC group(76.47% vs.7.14%,64.71% vs.0),and the differences were statistically significant(P < 0.05).The positive rates of serum anti-SSA antibody in the three groups were 17.65%,30.17% and 35.71%,respectively.The PBC group with ACA-positive was the lowest,and the non-PBC group with ACA-positive was the highest,and the difference was statistically significant(P <0.05).The positive rate of anti-SSB antibody in ACA-positive PBC group was lower than that in ACA-positive without liver manifestation group(3.92% vs 21.43%),and the positive rate of anti-SSB antibody in ACA-negative PBC group was lower than that in ACA-positive without liver manifestation group(11.64% vs 21.43%).In PBC patients,the median levels of serum Ig M[2.67(2.74)vs.1.85(2.23)] and Ig G[15.30(9.13)vs.12.75(4.60)] in ACA-positive group were higher than those in ACA-negative group,and the differences between the two groups were statistically significant(P < 0.05).In addition,There were no differences in the antinuclear antibody(ANA),anti-SP-100 antibody(SP-100),anti-GP-210 antibody(GP-210),anti-SM antibody(SM),anti-scl-70 antibody(SCL-70),anti-nucleosome antibody(ANu A),anti-histone antibody(AHA)and antiribonucleic acid protein antibody(RNP)among the three groups There was no significant difference in serum immunoglobulin A(Ig A)level between ACA-positive and ACA-negative PBC group(P > 0.05).The difference analysis of ACA-positive rate after AMA-M2 regrouping showed that the proportion of PBC patients with serum AMA-M2 positive and ACA-positive was lower than that of PBC patients with AMA-M2 negative and ACA-positive(27.73% and 37.50%).4.As for imaging examination,there were differences in the incidence of portal hypertension,splenomegaly,and gastrointestinal hemorrhage between ACA-positive group and ACA-negative group.The incidences of portal hypertension(35.29% vs.20.69%),splenomegaly(49.02% vs.35.78%),and gastrointestinal hemorrhage(7.84% vs.1.29%)in ACA-positive group were higher than those in ACA-negative group,and the differences were statistically significant(P < 0.05).The incidence of liver cirrhosis(48.04%vs.42.67%)was higher in ACA-positive group,and the difference was not statistically significant(P > 0.05).The incidence of gastric varices(17.65% vs.10.34%)and ascites(24.51% vs.17.67%)in the ACA-positive group was lower than those in the ACAnegative group,but the difference was not statistically significant(P > 0.05).5.In terms of histopathological stage,the number and proportion of patients with stage I and stage III in ACA-negative group were higher than those in ACA-positive group,and the proportion of patients with stage IV in ACA-positive group was higher.Conclusions:(1)ACA-positive PBC patients had an older onset age and a higher prevalence rate in females,which was different from ACA-negative PBC patients in terms of general information.(2)ACA has a high positive rate in PBC patients with AMA-M2 negative.(3)PBC patients with ACA-positive were more likely to develop fever symptoms and clinical complications such as cirrhosis,portal hypertension and splenomegaly. |
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