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Positive antimitochondrial antibody but normal alkaline phosphatase: Is this primary biliary cirrhosis?
Author(s) -
Mitchison Harriet C.,
Bassendine Margaret F.,
Hendrick Alex,
Bennett Mark K.,
Bird Graham,
Watson Alexander J.,
James Oliver F. W.
Publication year - 1986
Publication title -
hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.488
H-Index - 361
eISSN - 1527-3350
pISSN - 0270-9139
DOI - 10.1002/hep.1840060609
Subject(s) - primary biliary cirrhosis , alkaline phosphatase , medicine , gastroenterology , biliary cirrhosis , antibody , primary (astronomy) , chemistry , biochemistry , enzyme , immunology , disease , autoimmune disease , physics , astronomy
Abstract Twenty‐nine patients with a positive antimitochondrial antibody titer ≥1/40, who were detected during screening for other autoimmune disease, are described who had a normal serum bilirubin, alkaline phosphatase and transaminase and who had no symptoms of liver disease at presentation. Liver biopsies in 12 of the 29 fulfilled diagnostic criteria for primary biliary cirrhosis; a further 12 were consistent with primary biliary cirrhosis, but only 2 were normal. There was a high incidence of other autoantibodies and autoimmune diseases, especially thyroid antibodies and disorders. Sixteen of these patients have been followed for over 4 years since diagnosis (mean = 6 years, range = 4 to 9 years) and for a mean of 8.7 years since initial detection of the antimitochondrial antibody (range = 4 to 13). Five of 16 developed symptoms suggestive of primary biliary cirrhosis, and 11 of 16 developed elevation of alkaline phosphatase. The antimitochondrial antibody activity in these patients was in the same IgG subclasses (predominantly IgG 1 and IgG 3 ) as that seen in a group of 23 patients with clinically, biochemically and histologically advanced primary biliary cirrhosis. All showed the same abnormalities on quantitative estimation of the total IgG subclasses in serum; relative excess of IgG 3 and, to a lesser extent, IgG 2 was exhibited. It is concluded that, in this study, the finding of an antimitochondrial antibody titer ≥1/40 is strongly suggestive of primary biliary cirrhosis even in the absence of symptoms and the presence of a normal alkaline phosphatase.