Clinical significance of different antinuclear antibodies patterns in the course of primary biliary cirrhosis

Abstract

Background/aims: The significance of antinuclear antibodies (ANA) in primary biliary cirrhosis (PBC) patient is still controversial in the literature. The purpose of this paper is to investigate the clinical significance of ANA in PBC patients.

Materials and methods: Sixty-nine patients with PBC were investigated. Control groups included 21 patients with autoimmune hepatitis, 26 patients with alcoholic liver disease, 13 patients with systemic connective tissue disease and 27 healthy persons. ANA was detected by an immunofluorescence method on rat liver tissue sections and HEp-2 cells at serum dilution 1/40.

Results: In 48 out of 69 PBC patients (70%), ANA was positive in HEp-2 cell line, but in rat liver tissue sections only 29% of patients had positive ANA reactions. Most frequent patterns were multiple nuclear dots (MND) in 42% and perinuclear in 16%. MND-ANA was also found in two autoimmune hepatitis patients and in one systemic lupus erythematosus patient. Survival from the moment of developing first symptom(s) attributable to liver disease was longer in the ANA positive patients than ANA negative ones (p < 0.02). Despite immunosuppressive treatment, in most of ANA positive patients (73%) ANA did not disappear. Most frequent ANA patterns in autoimmune hepatitis and systemic connective tissue diseases patients were homogeneous and anticentromere, respectively.

Conclusions: Immunofluorescence method on HEp-2 cell line for ANA detection is more sensitive than on rat liver tissue sections. In PBC patient's incidence of ANA, especially MND-ANA is a frequent immunological abnormality. ANA positive patients have better prognosis for survival.