Interpreting Serological Tests in Diagnosing Autoimmune Liver Diseases

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Semin Liver Dis 2007; 27: 161-172

Interpreting Serological Tests in Diagnosing Autoimmune

Liver Diseases

Pietro Invernizzi,

Ana Lleo, Mauro Podda

Division of Internal Medicine and

Liver Unit, San Paolo Hospital School of Medicine, University of Milan,

Milan, Italy

ABSTRACT

Autoimmune

liver diseases (ALD) are characterized by immune-mediated injury of bile ducts

or hepatocytes, thus including cholangiopathies

such as primary biliary cirrhosis (PBC), primary sclerosing

cholangitis, and autoimmune hepatitis. Further, ALD variants manifesting with both hepatocellular and cholangiocellular

damage are becoming more common. Serum autoantibodies, together with imaging and histology, are

critical to the diagnostic process when ALD is suspected. Because

an early diagnosis can influence prognosis, the development of sensitive and

specific tests for serum autoantibodies should be a

priority for researchers to ensure a more efficient noninvasive workup. Little prognostic value has been observed for any of the

ALD serum hallmarks, and a vigorous effort to investigate new and old markers

should therefore be undertaken in longitudinal studies as in the recent

paradigm of PBC-specific antinuclear antibodies. We

review herein the numerous ALD screening tests available in routine and

specialized laboratories and comment on their significance in clinical practice.

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