Health Worlds

Primary biliary cirrhosis (PBC) is an autoimmune disease, occurs in middle-aged women, in most cases there is no clear diagnosis of clinical symptoms. Serum AMA positive rate is high, but not 100%. Although PBC is usually slow, but its survival rate compared with the same gender and age groups is low. Clinically manifested as fatigue, pruritus, portal hypertension, osteoporosis, skin yellow warts, fat-soluble vitamin deficiency and recurrent asymptomatic urinary tract infections. In addition, they can still associated with non-hepatic autoimmune abnormalities. PBC in recent years, increasing the detection rate, but its pathogenesis is still completely clarified the end of the treatment is also a lack of specific control measures. PBC has recently introduced treatment AASLD guidelines, designed to help physicians understand the PBC diagnosis, assessment of severity and associated with other abnormalities, and may be useful for some patients treatment, prevention recommendations.Many cases of PBC in the regular examination revealed serum anti-mitochondrial antibody (AMA) positive, without any symptoms and abnormal liver function. Serum AMA testing course also the possibility of false positive results.
1. Biochemical examination: liver-derived serum alkaline phosphatase (ALP) elevation is the most common biochemical abnormalities PBC. Despite the small number of patients at diagnosis based direct bilirubin bilirubin increased, but increased hyperbilirubinemia late for the


performance of PBC, and is a good indicator to determine the prognosis of PBC. In any chronic cholestatic liver disease, serum total cholesterol may be increased.
2. Bile duct imaging: for all patients with cholestatic hepatobiliary system should be carried out B-ultrasound. B-bile duct system of normal and AMA suggest positive patients do not need to be diagnosed cholangiopancreatography PBC. The diagnosis is not clear if the PBC or the sudden increase in serum bilirubin, the bile duct imaging is necessary.
3. Anti-mitochondrial antibody (AMA): AMA-positive serum is an important immunological features of PBC. The simplest and most cost effective method is to use rat stomach and kidney were determined by immunofluorescence. In PBC patients, AMA is generally present as a high titer (> 1:40), while low titer (<1:40) AMA-positive diagnosis of PBC is not specific, can be measured in the complex to negative. Determination of AMA for the most specific substrate for the 2 - oxidoreductase, it can be more specific immune spot technology to detect cases of AMA-positive PBC its specificity and sensitivity of detection of more than 95%. About 1 / 3 of the PBC patients antinuclear antibody and anti-smooth muscle antibodies.
4. Immune globulin: PBC patients with elevated immunoglobulin IgM-based, IgA is usually normal, but IgA deficiency reported. Ig generally used only for PBC detection of suspected cases. In AMA-negative patients, the increase of the IgG immunoglobulin-based, and IgM increase is not common.
5. Liver biopsy: the PBC AMA-positive and has a typical clinical presentation and biochemical abnormalities in patients with liver biopsy in the diagnosis is not required. PBC histologically divided into four phases: of the portal area of granulomatous inflammation associated with bile duct damage; period of bile duct hyperplasia accompanied by portal inflammation around; of spacing and bridging necrosis fibrous form; of the liver hardening period. Liver fibrosis and cirrhosis of the liver biopsy see a poor prognosis. The performance of the PBC histological damage to the main bile duct, it must have a sufficient number of samples of portal area organizations. Although the PBC histologically divided into four clear, but in a biopsy specimen, it can be both typical of the performance of different periods. However, no histological examination for the diagnosis of cirrhosis of the liver of PBC patients is not specific.
6. AMA-positive and normal liver function PBC: there is a group of scholars and ALP normal and asymptomatic AMA-positive patients, 29 patients were followed up for liver biopsy tissue and found 12 patients with liver histological diagnosis, only 2 patients with normal liver histology. 24 patients followed up for 10 years found that the AMA is still positive and significant in all cases evidence of cholestasis, of which 22 patients had clinical symptoms.
7. AMA negative PBC: Several scholars have reported that some PBC patients with typical clinical symptoms, biochemical and histological features of all the performance, but the AMA continued to negative. These patients are often described as


Friends Links:Automation Control Blog
Automation Products Order Numbers