Viêm gan tự miễn: Tự kháng thể trong huyết thanh trong thực hành lâm sàng

Clinical Reviews in Allergy - Tập 63 - Trang 124-137 - 2021
Benedetta Terziroli Beretta-Piccoli1,2,3, Giorgina Mieli-Vergani3,4, Diego Vergani3,5
1Epatocentro Ticino & Facoltà Di Scienze Biomediche, Università Della Svizzera Italiana, Lugano, Switzerland
2Institute for Research in Biomedicine, Bellinzona, Switzerland
3King’s College London Faculty of Life Sciences &, Medicine At King’s College Hospital, London, UK
4Paediatric Liver, GI and Nutrition Centre, MowatLabs, King's College Hospital, London, UK
5Institute of Liver Studies, MowatLabs, King's College Hospital, London, UK

Tóm tắt

Các tự kháng thể có trong tuần hoàn là một công cụ chẩn đoán quan trọng trong viêm gan tự miễn (AIH), có tỷ lệ dương tính đạt 95% nếu được kiểm tra theo những hướng dẫn chuyên biệt do Nhóm Viêm Gan Tự Miễn Quốc Tế ban hành. Chúng cũng cho phép phân biệt giữa viêm gan tự miễn type 1, được đặc trưng bởi sự hiện diện của kháng thể kháng nhân và/hoặc kháng antibody cơ trơn, và viêm gan tự miễn type 2, được đặc trưng bởi sự có mặt của kháng thể kháng microsome type 1 của gan thận và/hoặc kháng thể kháng citosol type 1 của gan. Kháng thể kháng kháng nguyên gan hòa tan là tự kháng thể duy nhất đặc hiệu cho AIH, xuất hiện trong 20-30% trường hợp của cả viêm gan tự miễn type 1 và type 2. Kháng thể kháng bạch cầu trung tính có thường xuyên dương tính trong viêm gan tự miễn type 1, cũng liên quan đến bệnh viêm ruột và viêm đường mật xơ hóa nguyên phát/tự miễn. Phương pháp tham chiếu để kiểm tra tự kháng thể vẫn là miễn dịch huỳnh quang gián tiếp trên ba loại mô (gan gặm nhấm, thận và dạ dày), cho phép phát hiện phần lớn các phản ứng liên quan đến gan, bao gồm cả những tự kháng thể có kháng nguyên mục tiêu phân tử chưa được biết đến. Đáng chú ý, kiến thức hiện tại về ý nghĩa lâm sàng của các tự kháng thể dựa trên các nghiên cứu dựa trên kỹ thuật này. Tuy nhiên, miễn dịch huỳnh quang yêu cầu nhân viên phòng thí nghiệm có trình độ, phụ thuộc vào người quan sát và thiếu tính chuẩn hóa, dẫn đến những nỗ lực liên tục để thay thế phương pháp này bằng các xét nghiệm tự động, nhưng độ nhạy và độ đặc hiệu của chúng cần được nghiên cứu thêm trước khi có thể được coi là phương pháp thay thế đáng tin cậy cho miễn dịch huỳnh quang; hiện tại, chúng có thể được sử dụng như một phương pháp bổ sung cho miễn dịch huỳnh quang.

Từ khóa

#viêm gan tự miễn #tự kháng thể #chẩn đoán #miễn dịch huỳnh quang #kháng thể kháng nhân #kháng thể kháng gan thận

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