glat-muskulatur-antistof-sma (LH Indholdsside)

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      <HtmlField Name="PageContent"><![CDATA[<h2>Resum&eacute;</h2>
<ul>
    <li>Anvendes&nbsp;ved mistanke om leversygdom, hvor virushepatitis kan udelukkes. </li>
    <li>Er forh&oslash;jet og blandt de diagnostiske kriterier for prim&aelig;r bili&aelig;r kolangitis (tidligere prim&aelig;r bili&aelig;r cirrose) og&nbsp;<a href="~/link.aspx?_id=A66FE392D12A45619D44C32ACE4ACCFF&amp;_z=z">Autoimmun hepatitis</a></li>
</ul>
<h2>Definition</h2>
<ul>
    <li>Koncentrationsbestemmelse af glat muskulatur-antistof (<strong>S</strong>mooth <strong>M</strong>uscle <strong>A</strong>ntibody) i serum, ved brug af indirekte immunfluorescens teknik (IIF)</li>
    <li>Antistofferne mod glatte muskelceller er oftest rettet mod&nbsp; proteinet actin. </li>
</ul>
<h2>Synonymer</h2>
<ul>
    <li>Synonymer: Smooth Muscle Antibody (SMA)&nbsp;</li>
</ul>
<h2>Indikationer<a href=" " data-type="journal-reference" data-value="Terziroli Beretta-Piccoli B, Mieli-Vergani G, Vergani D, Autoimmmune hepatitis. Cell Mol Immunol 2022;19: 158-176" data-value-piped="Terziroli Beretta-Piccoli B, Mieli-Vergani G, Vergani D|Autoimmmune hepatitis.|Cell Mol Immunol|2022|19|158-176|34580437" data-url="reference-link" data-pubmedid="34580437" title="Terziroli Beretta-Piccoli B, Mieli-Vergani G, Vergani D, Autoimmmune hepatitis. Cell Mol Immunol 2022;19: 158-176">1</a>,<a href="EditorPage.aspx?da=core&amp;id=%7B5D04A20A-9838-463B-8089-30A257AD2288%7D&amp;ed=FIELD8307323209&amp;vs&amp;la=da&amp;fld=%7B850D32D3-55A1-49E4-9CDF-F0C88D91563C%7D&amp;so=%2Fsitecore%2Fsystem%2FSettings%2FHtml%20Editor%20Profiles%2FRich%20Text%20LHPH&amp;di=0&amp;hdl=H8307323375&amp;mo&amp;pe=0&amp;fbd=1" data-type="journal-reference" data-value="Mack CL, Adams D, Assis DN, Kerkar N, Manns MP, Mayo MJ, Vierling JM, Alsawas M, Murad MH, Czaja AJ, Diagnosis and Management of Autoimmune Hepatitis in Adults and Children: 2019 Practice Guidance and Guidelines From the American Association for the Study of Liver Diseases. Hepatology 2020;72: 671-722" data-value-piped="Mack CL, Adams D, Assis DN, Kerkar N, Manns MP, Mayo MJ, Vierling JM, Alsawas M, Murad MH, Czaja AJ|Diagnosis and Management of Autoimmune Hepatitis in Adults and Children: 2019 Practice Guidance and Guidelines From the American Association for the Study of Liver Diseases.|Hepatology|2020|72|671-722|31863477" data-url="reference-link" data-pubmedid="31863477" title="Mack CL, Adams D, Assis DN, Kerkar N, Manns MP, Mayo MJ, Vierling JM, Alsawas M, Murad MH, Czaja AJ, Diagnosis and Management of Autoimmune Hepatitis in Adults and Children: 2019 Practice Guidance and Guidelines From the American Association for the Study of Liver Diseases. Hepatology 2020;72: 671-722">2</a>,<a href="https://dsgh.dk/lever/" data-type="other-reference" data-value="Guideline DSGH" data-url="https://dsgh.dk/lever/" title="Guideline DSGH">3</a>,<a href=" " data-type="journal-reference" data-value="Bossen L, Ytting H, Jepsen P, Hamberg O, Ott P, Grønbæk H, [New name and new treatments for primary biliary cholangitits]. Ugeskr Laeger 2018;180: " data-value-piped="Bossen L, Ytting H, Jepsen P, Hamberg O, Ott P, Grønbæk H|[New name and new treatments for primary biliary cholangitits].|Ugeskr Laeger|2018|180||29536837" data-url="reference-link" data-pubmedid="29536837" title="Bossen L, Ytting H, Jepsen P, Hamberg O, Ott P, Grønbæk H, [New name and new treatments for primary biliary cholangitits]. Ugeskr Laeger 2018;180: ">4</a></h2>
<ul>
    <li>Mistanke om&nbsp;<a href="~/link.aspx?_id=A66FE392D12A45619D44C32ACE4ACCFF&amp;_z=z">autoimmun hepatitis</a>&nbsp;typisk sammen med&nbsp;<a href="https://www.sundhed.dk/sundhedsfaglig/laegehaandbogen/undersoegelser-og-proever/klinisk-biokemi/blodproever/ana-screening-antinukleaere-antistoffer-hep-2-celler-moenster-antinukleaere-igg-antistoffer/">ANA&nbsp;</a>
    <ul>
        <li>Virushepatitis udelukket</li>
    </ul>
    </li>
    <li>Mistanke om&nbsp;<a href="~/link.aspx?_id=C79829A552DC4EC2A96AF23B5E67912E&amp;_z=z">prim&aelig;r bili&aelig;r </a>kolangitis</li>
    <li>Uklart billede ved leversygdom, hvor virushepatitis kan udelukkes</li>
    <li>Stillingtagen til&nbsp;<a href="~/link.aspx?_id=6E31C3A55906410EAD5891C17B65E869&amp;_z=z">leverbiopsi</a></li>
</ul>
<h2>Fortolkninger<a href="%20" title="Lyngbye J, Kjær A, Ladefoged S, Nissen PH. Lyngbyes laboratoriemedicin. 2 udg.. København: Nyt Nordisk Forlag Arnold Busck A/S; 2010" data-url="reference-link" data-value-piped="Lyngbye J, Kjær A, Ladefoged S, Nissen PH|Lyngbyes laboratoriemedicin. 2 udg.|København| Nyt Nordisk Forlag Arnold Busck A/S|2010" data-value="Lyngbye J, Kjær A, Ladefoged S, Nissen PH. Lyngbyes laboratoriemedicin. 2 udg.. København: Nyt Nordisk Forlag Arnold Busck A/S; 2010" data-type="book-reference">5</a><sup>,</sup><a href="%20" title="Leung PS et al, Etiology of primary biliary cirrhosis: the search for the culprit. Review. Semin Liver Dis 2005;25: 327-36" data-url="reference-link" data-value-piped="Leung PS et al|Etiology of primary biliary cirrhosis: the search for the culprit. Review|Semin Liver Dis |2005|25|327-36" data-value="Leung PS et al, Etiology of primary biliary cirrhosis: the search for the culprit. Review. Semin Liver Dis 2005;25: 327-36" data-type="journal-reference">6</a>,<a href=" " data-type="journal-reference" data-value="Tanaka A, Autoimmune Hepatitis: 2019 Update. Gut Liver 2020;14: 430-438" data-value-piped="Tanaka A|Autoimmune Hepatitis: 2019 Update.|Gut Liver|2020|14|430-438|32301319" data-url="reference-link" data-pubmedid="32301319" title="Tanaka A, Autoimmune Hepatitis: 2019 Update. Gut Liver 2020;14: 430-438">7</a>,<a href="EditorPage.aspx?da=core&amp;id=%7B5D04A20A-9838-463B-8089-30A257AD2288%7D&amp;ed=FIELD8307323209&amp;vs&amp;la=da&amp;fld=%7B850D32D3-55A1-49E4-9CDF-F0C88D91563C%7D&amp;so=%2Fsitecore%2Fsystem%2FSettings%2FHtml%20Editor%20Profiles%2FRich%20Text%20LHPH&amp;di=0&amp;hdl=H8307323375&amp;mo&amp;pe=0&amp;fbd=1" data-type="journal-reference" data-value="Terziroli Beretta-Piccoli B, Mieli-Vergani G, Vergani D, Autoimmmune hepatitis. Cell Mol Immunol 2022;19: 158-176" data-value-piped="Terziroli Beretta-Piccoli B, Mieli-Vergani G, Vergani D|Autoimmmune hepatitis.|Cell Mol Immunol|2022|19|158-176|34580437" data-url="reference-link" data-pubmedid="34580437" title="Terziroli Beretta-Piccoli B, Mieli-Vergani G, Vergani D, Autoimmmune hepatitis. Cell Mol Immunol 2022;19: 158-176">1</a>,<a href=" " data-type="journal-reference" data-value="Mack CL, Adams D, Assis DN, Kerkar N, Manns MP, Mayo MJ, Vierling JM, Alsawas M, Murad MH, Czaja AJ, Diagnosis and Management of Autoimmune Hepatitis in Adults and Children: 2019 Practice Guidance and Guidelines From the American Association for the Study of Liver Diseases. Hepatology 2020;72: 671-722" data-value-piped="Mack CL, Adams D, Assis DN, Kerkar N, Manns MP, Mayo MJ, Vierling JM, Alsawas M, Murad MH, Czaja AJ|Diagnosis and Management of Autoimmune Hepatitis in Adults and Children: 2019 Practice Guidance and Guidelines From the American Association for the Study of Liver Diseases.|Hepatology|2020|72|671-722|31863477" data-url="reference-link" data-pubmedid="31863477" title="Mack CL, Adams D, Assis DN, Kerkar N, Manns MP, Mayo MJ, Vierling JM, Alsawas M, Murad MH, Czaja AJ, Diagnosis and Management of Autoimmune Hepatitis in Adults and Children: 2019 Practice Guidance and Guidelines From the American Association for the Study of Liver Diseases. Hepatology 2020;72: 671-722">2</a></h2>
<h3>Positiv for SMA-antistof</h3>
<ul>
    <li>St&aelig;rkt positiv SMA-antistof
    <ul>
        <li>Autoimmun hepatitis Type 1 (den hyppigste): 85-95 %</li>
        <li>Prim&aelig;r bili&aelig;r kolangitis: 90 %</li>
    </ul>
    </li>
    <li>Titer-niveau korrelerer med sygdomsaktivitet for autoimmun hepatitis Type 1<a href="EditorPage.aspx?da=core&amp;id=%7B5D04A20A-9838-463B-8089-30A257AD2288%7D&amp;ed=FIELD8307323209&amp;vs&amp;la=da&amp;fld=%7B850D32D3-55A1-49E4-9CDF-F0C88D91563C%7D&amp;so=%2Fsitecore%2Fsystem%2FSettings%2FHtml%20Editor%20Profiles%2FRich%20Text%20LHPH&amp;di=0&amp;hdl=H8307323375&amp;mo&amp;pe=0&amp;fbd=1" data-type="journal-reference" data-value="Terziroli Beretta-Piccoli B, Mieli-Vergani G, Vergani D, Autoimmmune hepatitis. Cell Mol Immunol 2022;19: 158-176" data-value-piped="Terziroli Beretta-Piccoli B, Mieli-Vergani G, Vergani D|Autoimmmune hepatitis.|Cell Mol Immunol|2022|19|158-176|34580437" data-url="reference-link" data-pubmedid="34580437" title="Terziroli Beretta-Piccoli B, Mieli-Vergani G, Vergani D, Autoimmmune hepatitis. Cell Mol Immunol 2022;19: 158-176">1</a></li>
    <li>Middel eller svag positiv
    <ul>
        <li>Kronisk inflammatorisk sygdom</li>
        <li>Malign sygdom</li>
    </ul>
    </li>
    <li>Akut virushepatitis: 10-30 %</li>
    <li>SMA er sj&aelig;ldent til stede ved
    <ul>
        <li>Ekstrahepatisk galdegangsobstruktion</li>
        <li>Medikamentel-induceret leversygdom</li>
        <li>Akut alkoholisk leversygdom</li>
        <li>Hepatom</li>
    </ul>
    </li>
    <li>Svag positiv
    <ul>
        <li>Raske personer: 3-7 %</li>
    </ul>
    </li>
</ul>
<h2>Fejlkilder (og kilder til normal variation)</h2>
<ul>
    <li>SMA kan p&aring;vises hos raske&nbsp;(&lt; 3 %)</li>
</ul>
<h2>Biokemisk baggrund&nbsp;<a href="%20" title="Lyngbye J, Kjær A, Ladefoged S, Nissen PH. Lyngbyes laboratoriemedicin. 2 udg.. København:  Nyt Nordisk Forlag Arnold Busck A/S; 2010" data-url="reference-link" data-value-piped="Lyngbye J, Kjær A, Ladefoged S, Nissen PH|Lyngbyes laboratoriemedicin. 2 udg.|København| Nyt Nordisk Forlag Arnold Busck A/S|2010" data-value="Lyngbye J, Kjær A, Ladefoged S, Nissen PH. Lyngbyes laboratoriemedicin. 2 udg.. København:  Nyt Nordisk Forlag Arnold Busck A/S; 2010" data-type="book-reference">8</a>,<a href="EditorPage.aspx?da=core&amp;id=%7B5D04A20A-9838-463B-8089-30A257AD2288%7D&amp;ed=FIELD8307323209&amp;vs&amp;la=da&amp;fld=%7B850D32D3-55A1-49E4-9CDF-F0C88D91563C%7D&amp;so=%2Fsitecore%2Fsystem%2FSettings%2FHtml%20Editor%20Profiles%2FRich%20Text%20LHPH&amp;di=0&amp;hdl=H8307323375&amp;mo&amp;pe=0&amp;fbd=1" data-type="journal-reference" data-value="Terziroli Beretta-Piccoli B, Mieli-Vergani G, Vergani D, Autoimmmune hepatitis. Cell Mol Immunol 2022;19: 158-176" data-value-piped="Terziroli Beretta-Piccoli B, Mieli-Vergani G, Vergani D|Autoimmmune hepatitis.|Cell Mol Immunol|2022|19|158-176|34580437" data-url="reference-link" data-pubmedid="34580437" title="Terziroli Beretta-Piccoli B, Mieli-Vergani G, Vergani D, Autoimmmune hepatitis. Cell Mol Immunol 2022;19: 158-176">1</a></h2>
<ul>
    <li>Relaterede analyser: <a href="~/link.aspx?_id=7103A16D4BDA4459A6C8E5317BA865A4&amp;_z=z">P-Mitokondrie-antistof</a> (AMA) </li>
    <li>SMA antistofferne (IgG) er cirkulerende og prim&aelig;rt rettet mod hepatocytcelleoverflade-antigener i form af actin og andre komponenter i cellev&aelig;ggen og cytoskelet </li>
    <li>Findes hos mindre end 3 % af normalbefolkningen&nbsp; </li>
    <li>Dannelsen af SMA menes at v&aelig;re sekund&aelig;r til levercelleskaden </li>
    <li>H&oslash;j titer af SMA ses ved autoimmun kronisk aktiv hepatitis og ved bili&aelig;r cirrose </li>
    <li>SMA kan af og til erkendes ved <a href="~/link.aspx?_id=2640007DD8FD40799AB19A8BEB188D26&amp;_z=z">ANA-screening</a> (m&oslash;nster 5)</li>
    <li><a href="~/link.aspx?_id=A66FE392D12A45619D44C32ACE4ACCFF&amp;_z=z">Autoimmun hepatitis</a>&nbsp;deles i to typer
    <ul>
        <li>Type 1, ca. 90 %, rammer oftere kvinder end m&aelig;nd, og ses oftere hos patienter med andre autoimmune sygdomme. Er positiv for ANA, SMA eller anti-SLA/LP og er associeret med HLA DR3, DR4 og DR13. Kan debutere i alle aldre og har et variabel klinisk og histopatologisk sv&aelig;rhed</li>
        <li>Type 2, ca. 10 %, rammer oftest b&oslash;rn eller yngre. Er positiv for&nbsp;Anti-LKM1, anti-LC1 og sj&aelig;ldnere anti-LKM3. Er associeret med HLA DR3 og DR7.&nbsp;<br>
        Klinisk og histopatologisk ofte akut, alvorligere og mere avanceret</li>
    </ul>
    </li>
</ul>
<h2>Pr&oslash;vetagning</h2>
<ul>
    <li>Veneblodpr&oslash;ve
    <ul>
        <li>Serum &ndash; r&oslash;r uden antikoagulans - r&oslash;d prop med eller uden gel</li>
    </ul>
    </li>
    <li>P&aring; samme r&oslash;r kan udf&oslash;res AMA</li>
</ul>
<h2>Referenceintervaller/svarafgivelse</h2>
<h3>P-Glat muskulatur antistof (SMA)</h3>
<ul>
    <li>Negativ</li>
</ul>
<h3>Svarafgivelse</h3>
<ul>
    <li>Positive svar semikvantiteres i svagt, middel eller st&aelig;rkt positiv ud fra fluorescens intensiteten ved serum fortyndet 1:20</li>
</ul>
<h2>NPU-koder og -navne</h2>
<ul>
    <li>NPU12996</li>
</ul>
<h3>Navne</h3>
<ul>
    <li><strong>Langt navn</strong>
    <ul>
        <li>P&mdash;Glat muskel-antistof(IgG); arb.k.(proc.) = ?&nbsp;</li>
    </ul>
    </li>
    <li><strong>Kort navn</strong>
    <ul>
        <li>Glat muskel-IgG [GMA];P</li>
    </ul>
    </li>
</ul>
<h2>Analysetest</h2>
<ul>
    <li>Indirekte immunfluorescens teknik (IIF) med snit af glat muskulatur fra rotteventrikel som antigen</li>
</ul>
<h2>Opf&oslash;lgning p&aring; unormale resultater</h2>
<ul>
    <li>Specialistopgave
    <ul>
        <li>Indikation for leverbiopsi mhp. diagnose </li>
    </ul>
    </li>
    <li>Ved kronisk hepatitis hos unge kvinder med negativ SMA og AMA b&oslash;r der udf&oslash;res ANA- og <a href="~/link.aspx?_id=E03C4CD038024EA0864C445B8BA1F1F4&amp;_z=z">ANCA screening</a> </li>
    <li>AMA</li>
</ul>]]></HtmlField>
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