Objective: To investigate the clinical and laboratory features of patients with liver disease and positive anti-liver/kidney microsomal-1 (anti-LKM-1) antibody, and to provide a reference for clinical diagnosis and differential diagnosis. Methods: The clinical data of patients with positive anti-LKM-1 antibody who were treated in our hospital from 2006 to 2016 were collected, and clinical and laboratory features were analyzed and compared. An analysis was also performed for special cases. Results: The measurement of related autoantibodies was performed for about 100 thousand case-times, and 15 patients were found to have positive anti-LKM-1 antibody. Among the 15 patients, 7 were diagnosed with type 2 autoimmune hepatitis (AIH) with an age of 11.0 ± 9.0 years and were all adolescents with acute onset; 8 were diagnosed with hepatitis C with an age of 51.5 ± 9.0 years, among whom 7 were middle-aged patients and 1 was a child aged 12 years, and all of them had an insidious onset. Compared with the patients with hepatitis C, the AIH patients had significantly higher levels of alanine aminotransferase (1 003.9 ± 904.3 U/L vs 57.0 ± 84.1 U/L, P < 0.05), aspartate aminotransferase (410.7 ± 660.3 U/L vs 34.9 ± 42.9 U/L, P < 0.05), and total bilirubin (98.0 ± 191.0 μmol/L vs 15.4 ± 6.0 μmol/L, P < 0.05). There was a reduction in immunoglobulin G after the treatment with immunosuppressant, compared with the baseline. Of all 8 patients with hepatitis C, 6 received antiviral therapy with interferon and ribavirin, and 5 out of them achieved complete response, among whom 4 had a reduction in the level of anti-LKM-1 antibody after treatment; however, a 12-year-old child developed liver failure after interferon treatment and died eventually. Conclusion: Positive anti-LKM-1 antibody is commonly seen in patients with type 2 AIH or hepatitis C, but there are differences between these two groups of patients in terms of age, disease onset, liver function, and the level of anti-LKM-1 antibody. The hepatitis C patients with a confirmed diagnosis and exclusion of autoimmune hepatitis can achieve good response to interferon under close monitoring, even if anti-LKM-1 antibody is positive. As for adolescent patients with hepatitis C and positive anti-LKM-1 antibody, the possibility of AIH should be excluded.
目的： 分析抗肝肾微粒体（LKM-1）抗体阳性肝病患者临床及实验室特点，为临床诊断及鉴别诊断提供参考。 方法： 收集2006年至2016年住院及门诊患者中抗-LKM-1阳性患者病历资料，对其临床及实验室特点进行分析比较，并对其中特殊病例进行分析。 结果： 在肝功能异常患者中检测相关自身抗体117 452例次，发现抗-LKM-1阳性15例，其中诊断为2型自身免疫性肝炎（AIH）患者7例，年龄（11.0±9.0）岁，均为青少年，多急性起病；诊断为丙型肝炎患者8例，年龄（51.5±9.0）岁，其中7例为中年患者，1例12岁儿童患者，均隐匿起病。AIH患者丙氨酸氨基转移酶（1 003.9±904.3）U/L、天冬氨酸氨基转移酶（410.7±660.3）U/L、总胆红素（98.0±191.0）μmol/L，明显高于丙型肝炎患者的（57.0±84.1）U/L、（34.9±42.9）U/L、（15.4±6.0）μmol/L，P值均< 0.05，差异均有统计学意义。免疫抑制剂治疗后免疫球蛋白G较基线值降低。8例丙型肝炎患者中共6例接受干扰素联合利巴韦林抗病毒治疗，5例完全应答,其中4例治疗后抗-LKM-1水平下降。但1例12岁儿童应用干扰素治疗过程中发生肝衰竭，最终病死。 结论： 抗-LKM-1阳性患者主要见于2型AIH和丙型肝炎，但两组患者年龄、起病方式、肝功能、抗-LKM-1水平等存在差异；对诊断明确，可以排除自身免疫性肝炎的丙型肝炎患者，即使存在抗-LKM-1阳性，在密切监控下使用干扰素治疗，可以获得良好应答；对伴有抗-LKM-1阳性的青少年丙型肝炎患者，需进一步除外合并AIH。.
Keywords: Diagnosisi; Hepatitis C; Hepatitis, autoimmune; Liver and kidney microsome type 1 antibody.