Journal
JOURNAL OF AUTOIMMUNITY
Volume 99, Issue -, Pages 33-38Publisher
ACADEMIC PRESS LTD- ELSEVIER SCIENCE LTD
DOI: 10.1016/j.jaut.2019.01.005
Keywords
Antimitochondrial antibody; Alkaline phosphatase; Histology; Cholangitis activity; Primary biliary cholangitis
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Funding
- National Natural Science Foundation of China [81620108002, 81771732, 81830016, 81421001, 81570469, 81570511, 81770563, 81500435]
- Shanghai Municipal Education Commission-Gaofeng Clinical Medicine Grant Support [20161311]
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Background and aims: The most highly directed and specific autoantibody in human immunopathology is the serologic hallmark of primary biliary cholangitis (PBC), antimitochondrial antibodies (AMAs). However the clinical significance of finding a positive AMA, with normal alkaline phosphatase (ALP) remains enigmatic. Methods: We took advantage of 169 consecutive outpatients who were identified as having a positive AMA, but normal ALP levels between January 2012 and January 2018. A liver biopsy was performed on 67/169 of these AMA positive normal ALP patients. Results: In all 169 patients we reconfirmed the AMA and also performed anti-gp210 and anti-sp100, liver stiffness (LSM) assessed by vibration-controlled transient elastography (VCTE), an abdominal computed tomography (CT) scan, and either a magnetic resonance imaging (MRI) or ultrasound. The liver biopsies were reviewed by two unbiased observers. 87.6% of the 169 patients were females with a mean age of 46; the median AMA titer 1:320; an elevated serum IgM was found in 53.3%. Importantly, in patients with a liver biopsy, 55 ( 82.1%) out of 67 had varying degrees of cholangitis activity, diagnostic of PBC. Conclusion: In patients who were AMA-positive but had normal ALP levels, more than 80% were associated with histological classic PBC. These data emphasize the importance of a positive AMA, even with a normal ALP and also question the role of ALP as a sole surrogate marker of cholangitis.
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