Een retrospectieve studie naar de rol van antistoffen tegen oplosbaar ('soluble') leverantigeen (anti-SLA-antistoffen) en van andere autoantistoffen bij de diagnostiek van auto-immune hepatitis

To determine the diagnostic value of antibodies against soluble liver antigen (anti-SLA antibodies) and a number of other antibodies for the diagnosis of autoimmune hepatitis (AIH).

Design

Retrospective.

Method

Anti-SLA, antinuclear antibodies (ANA), antibodies against smooth muscle (anti-SMA), anti-neutrophil cytoplasm antibodies (perinuclear pattern; pANCA) and antibodies against liver-kidney microsomal antigen type 1 (anti-LKM-1) were determined in the sera of 97 patients with AIH and 121 patients with other liver disorders including viral, drug-related and alcoholic liver disease. The sensitivity and specificity of each of the antibodies, or a combination of antibodies, were calculated for the diagnosis ‘AIH’.

Results

Anti-SLA antibodies were found only in AIH patients (specificity: 100); 1 in 7 AIH patients (14) had these antibodies and in 2 they were the only detectable antibodies. Anti-LKM-1 antibodies also showed a 100 specificity for AIH although the sensitivity was much lower (2). Whilst the sensitivity of ANA (53), pANCA (39) and SMA (39) was higher, the specificity of these antibodies for AIH was lower. 20 of AIH patients tested negative for all autoantibodies. The simultaneous presence of more than one antibody increased the probability of AIH diagnosis.

Conclusion

When AIH is suspected, the presence of one or a combination of anti-SLA, ANA, anti-SMA, anti-LKM-1 and pANCA antibodies is helpful for the often difficult differential diagnosis between AIH and other liver disorders. Anti-SLA antibodies are specific for AIH and appear to be a useful diagnostic parameter.

Ned Tijdschr Geneeskd. 2006;150:490-4