血清PAB、ASCA、ANCA和GAB单项或联合检测在炎症性肠病诊断中的价值

目的 评估血清抗胰腺腺泡抗体（PAB）、抗酿酒酵母抗体（ASCA）、抗中性粒细胞胞浆抗体（ANCA）和抗小肠杯状细胞抗体（GAB）的IgG和IgA在IBD诊断及鉴别诊断中的临床价值。方法 选择2019年6月至2021年3月在上海交通大学医学院附属新华医院确诊的165例IBD患者,以及同期就诊的145例其他消化道疾病患者作为研究对象。采用间接免疫荧光法检测血清中PAB、ASCA、ANCA和GAB的IgG和IgA。比较各组的抗体阳性率,以及抗体单项和联合检测在IBD诊断及鉴别诊断中的效能。比较不同临床表型的CD患者的血清ASCA表达情况。结果 PAB、ASCA、ANCA的IgG和（或）IgA阳性率在IBD组与非IBD组、CD组与UC组之间的差异均有统计学意义（P均<0.05）,而GAB的IgG和IgA阳性率在各组间差异均无统计学意义（P均>0.05）。ASCA IgG阳性率在CD组与UC组间差异无统计学意义（P>0.05）。单项检测PAB、ASCA、ANCA的IgG和（或）IgA用于鉴别诊断IBD与非IBD疾病、CD与UC时,PAB IgG的约登指数和阳性似然比均最高。抗...     

食物不耐受特异性IgG抗体阳性566例分析

目的:分析食物不耐受特异性IgG抗体在不同疾病中的分布和意义,以及与年龄和性别的相关性。方法:采用ELISA法检测566例患者血清中食物不耐受特异性IgG抗体水平。结果:566例食物不耐受特异性IgG抗体阳性患者中48.59%表现为皮肤症状,45.76%表现为消化道症状,5.65%表现为其他症状。皮肤、消化系统2组患者中,鸡蛋、螃蟹的不耐受阳性率组间比较差异均无统计学意义(均P0.05),而牛奶的不耐受阳性率组间比较差异有统计学意义(P0.05)。在不同性别组中,鸡蛋、螃蟹、大豆、大米的不耐受阳性率比较差异无统计学意义,牛奶的不耐受阳性率差异有统计学意义。不同年龄组中,鸡蛋、牛奶、螃蟹的不耐受阳性率比较差异有统计学意义,大豆、大米的不耐受阳性率比较差异无统计学意义。结论:食物不耐受筛查有助于某些病因不明的患者的诊断和治疗,不同性别、年龄段对食物不耐受的种类有一定差别。     

特异性免疫球蛋白G抗体检测在支气管哮喘诊治中的意义

目的探讨食物特异性免疫球蛋白G(IgG)抗体检测在支气管哮喘临床诊治中的意义。方法支气管哮喘诊断标准的患者76例为试验组,69例健康体检者为对照组,分别抽取静脉血并用酶联免疫吸附试验(ELISA)半定量检测血清中14种食物特异性IgG抗体水平。结果试验组患者血清食物特异性IgG抗体检测阳性率(42.11%)明显高于对照组(8.69%)(P0.05),但不同年龄组患者存在不同食物特异性IgG抗体阳性,且不同年龄组间比较差异具有统计学意义(P0.05)。结论支气管哮喘与食物特异性IgG抗体的阳性程度存在一定联系,通过检测特异性IgG抗体水平,有助于对支气管哮喘患者进行饮食干预,指导预防。     

健康体检人群食物过敏原特异性IgG抗体的多因素分析

目的 探讨健康体检人群食物过敏原特异性IgG抗体的相关因素.方法 采用酶联免疫吸附试验检测970例健康体检者的14种血清食物过敏原特异性IgG抗体,并应用多因素非条件Logistic回归分析.结果 14种食物不耐受检测阳性560例,阳性率57.73％.IgG抗体阳性率最高的3种食物为螃蟹(49.59％)、鸡蛋(44.12％)和海虾(40.21％),不耐受最低的是猪肉(0.52％)和小麦(0.62％);螃蟹、鸡蛋、海虾、牛奶、西红柿5种食物不耐受存在性别差异,IgG抗体水平女性高于男性(P＜0.05);食物不耐受IgG抗体水平随年龄增长而升高,分级与年龄存在相关性(P＜0.01).Logistic回归分析显示,IgG抗体水平升高与BMI下降者和有过敏史呈正相关(P均＜0.05).结论 健康体检人群食物不耐受及其程度与性别、年龄、过敏体质和BMI等因素有关.5种食物不耐受者中女性多于男性,41 ～60岁是峰值年龄段,保持适宜体质量和健康教育可降低食物不耐受发生的风险.     

食物特异性IgG抗体检测在儿童慢性消化系统疾病中的应用价值

目的:探讨食物特异性IgG抗体检测在儿童慢性消化系统疾病中的应用价值.方法:比较106例慢性消化系统疾病患儿(观察组)和106例消化系统正常(对照组)患儿14种食物特异性IgG阳性率、血清食物特异性IgG检测阳性率以及出生后4 mo内喂养方式.结果:两组患儿14种食物特异性IgG阳性率较高的均为鸡蛋(61.32%,18.87%)和牛奶(43.40%,11.32%);观察组患儿牛奶、鸡蛋和大豆阳性率均显著高于对照组(43.40%v11.32%)、(61.32%vs 18.87%)、(11.32%v0.00%),差异具有统计学意义(P<0.05).观察组患儿2种食物阳性、3种及以上食物阳性以及总阳性率均显著高于对照组(34.91%v13.21%)、(15.09%vs 4.72%)、(85.85%v49.06%),差异具有统计学意义(P<0.05).观察组患儿出生后4 mo内母乳喂养率显著低于对照组(43.40%vs 76.42%),人工喂养和混合喂养率均显著高于对照组(8.49%vs 1.89%)、(48.11%v s 21.70%),差异具有统计学意义(P<0.05).结论:食物特异性IgG抗体检测能够发现由食物不良反应所致的慢性消化系统疾病,牛奶和鸡蛋为常见食物特异性IgG阳性食物,早期喂养方式是导致食物不耐受的重要因素.     

食物不耐受特异性IgG抗体阳性在不同疾病中的分布及临床意义

目的探讨食物不耐受特异性IgG抗体阳性在不同疾病中的分布及临床意义。方法选取2009年2月—2012年2月我院收治的食物不耐受特异性IgG抗体阳性患者187例,分析食物不耐受特异性IgG抗体阳性在不同疾病中的分布。结果皮肤症状患者食物不耐受特异性IgG抗体阳性率为57.75%(108/187),高于其他疾病患者〔消化道症状患者为17.11%(32/187),肾脏病患者为11.23%(21/187),呼吸系统疾病患者为10.70%(20/187),其他疾病为3.21%(6/187)〕(P0.05)。皮肤、消化道、呼吸系统疾病、肾脏病患者对鸡蛋的不耐受阳性率均较其他食物引起的高(P0.05)。结论对有慢性疾病症状却不能明确病因者,可对食物不耐受进行筛查,以有利于临床诊断和治疗。     

核周型抗中性粒细胞胞质抗体在溃疡性结肠炎患者中的意义

背景:核周型抗中性粒细胞胞质抗体(pANCA)阳性是诊断溃疡性结肠炎(UC)的特异性指标,但与疾病严重程度和疾病分期的相关性有待进一步研究。目的:探讨pANCA在UC患者中的意义。方法:选取2008年1月~2012年9月北京军区总医院125例UC患者,采用间接免疫荧光法检测血清pANCA,回顾性分析其与临床特征的相关性。结果:UC患者血清pANCA阳性率显著高于健康对照组(51.2%对0,P0.05)。活动期UC血清pANCA阳性率显著高于缓解期(57.9%对11.1%,P0.05),而不同临床类型、严重程度、病变范围之间无明显差异(P0.05)。结论:UC患者血清pANCA阳性率可能与疾病分期有关,与临床类型、严重程度、病变范围等无关。     

克罗恩病和溃疡性结肠炎食物不耐受的差异分析

背景:炎症性肠病(IBD)的发生、发展与饮食关系密切,食物不耐受在IBD中的发生情况及其与IBD的关系尚不十分清楚。目的:探讨活动期克罗恩病(CD)和溃疡性结肠炎(UC)患者中食物不耐受的差异。方法:选取2016年1月—2017年11月中南大学湘雅医院确诊的活动期134例CD、67例UC患者和42名正常对照者。以ELISA法检测14种食物的血清特异性IgG,据此评价食物不耐受情况,分析CD和UC患者食物不耐受的差异。结果:CD和UC患者食物不耐受阳性率均显著高于对照组(P 0. 001),CD患者又明显高于UC患者(P 0. 001)。三组间食物不耐受程度相比差异有统计学意义(F=46. 707,P 0. 001)。CD患者4种和6种食物不耐受的发生率均明显高于UC患者(P 0. 001)。与UC患者相比,病变累及结肠的CD患者的食物不耐受率无明显差异(P=0. 100),而累及小肠的CD患者明显升高(P=0. 010)。多元Logistic回归分析显示,食物不耐受≥4种为病变累及小肠的CD的危险因素(P=0. 040)。结论:CD和UC患者的食物不耐受阳性率均明显高于对照组,CD患者食物不耐受发生率高、程度重、种类多,病变累及小肠的CD患者的食物不耐受发生率明显高于结肠型CD和UC患者,食物不耐受≥4种可能为小肠型CD的预测因素。     

抗酿酒酵母细胞抗体在原发性胆汁性肝硬化患者中的临床意义

目的 检测原发性胆汁性肝硬化(PBC)患者血清抗酿酒酵母细胞抗体(ASCA),探讨其在PBC中的阳性状况和临床意义.方法 采用酶联免疫吸附试验(ELISA)检测162例PBC患者、44例自身免疫性肝炎(AIH)患者、41例肝病对照组(LDC)患者、144例炎症性肠病(IBD)患者及35名健康体检者血清ASCA的IgA和IgG亚型.采用χ2检验和非参数U检验进行分析.结果 ASCA-IgA在PBC患者中的阳性率为24.1%,高于溃疡性结肠炎(UC)组11.6%(χ2=5.5,P＜0.05)和健康对照组0(χ2=10.5,P＜0.01),与AIH组(20.5%)、LDC组(14.6%)和克罗恩病(CD)组(34.5%)比较,差异无统计学意义(P＞0.05);ASCA-IgG在PBC患者中的阳性率为11.1%,明显低于CD组27.6%(χ2=8.9,P＜0.01),高于健康对照组0(χ2=10.5,P＜0.01),与AIH组(15.9%)、LDC组(7.3%)和UC组(8.1%)比较,差异无统计学意义(P＞0.05);ASCA-IgA和IgG同时阳性的PBC患者仅占6.2%,显著低于CD组17.2%(χ2=6.3,P＜0.05);ASCA-IgA或IgG阳性的PBC患者占29.0%,显著低于CD组44.8%(χ2=4.8,P＜0.05),高于UC组(χ2=5.9,P＜0.05)和健康对照组(χ2=13.3,P＜0.01).抗GP210抗体阳性的PBC患者ASCA阳性率高于抗GP210抗体阴性PBC患者(38.6%和23.8%,χ2=3.9,P＜0.05);抗线粒体抗体(AMA)、抗SP100抗体阳性和阴性PBC患者间ASCA的阳性率差异无统计学意义.ASCA-IgA阳性PBC患者总胆红素、直接胆红素、总胆汁酸、乳酸脱氢酶(LD)、IgA、IgM、红细胞沉降率(ESR)高于ASCA-IgA阴性PBC患者,而白蛋白(ALB)、白蛋白/球蛋白和胆碱酯酶低于ASCA-IgA阴性PBC患者(P均＜0.05).ASCA-IgG阳性PBC患者与阴性患者间肝功能损伤指标和免疫功能指标差异均无统计学意义.结论 ASCA并不是IBD特异性自身抗体,在PBC患者有较高的阳性率,且以IgA亚型为主.ASCA-IgA与PBC患者肝功能损伤指标和免疫活动指标改变有关,而ASCA-IgG与PBC患者肝功能损伤指标和免疫活动指标改变无关.     

苏州地区克罗恩病患者食物不耐受的临床意义

背景:炎症性肠病(IBD)是一组病因不明的慢性非特异性肠道炎症性疾病,既往研究发现食物不耐受可能与其发病有关。目的:调查我国苏州地区克罗恩病(CD)患者的食物不耐受发生情况并探讨其临床意义。方法:纳入2007年3月—2015年8月苏州大学附属第一医院确诊IBD患者100例,其中CD 50例,溃疡性结肠炎(UC)50例。以食物过敏原IgG抗体检测试剂盒(ELISA法)检测14种食物的血清特异性IgG,据此评价食物不耐受情况,分析食物不耐受与CD疾病特点的关系。结果:与UC患者相比,CD患者更易发生食物不耐受(98.0%对72.0%)且敏感度更高(P=0.000 1)。CD患者糖类和蛋白质类食物不耐受发生率较高,统计学分析显示一种或多种食物不耐受与患者确诊年龄、病变部位、疾病行为、合并肛周病变、瘘管和疾病活动有关(P0.05);对糖类、蛋白质类食物不耐受者,病变部位多为末端回肠(LI);疾病处于活动期时,可表现为对多种食物不耐受。结论:苏州地区CD患者较UC患者更易发生食物不耐受,尤其是末端回肠型CD患者,以糖类、蛋白质类食物不耐受为主。食物不耐受与CD病情活动、进展和肛周病变、瘘管有明显联系。     

Insecure Attachment in a Subgroup with Ulcerative Colitis Defined by ANCA Status

This study is the first test of the novel hypothesis that perinuclear anti-neutrophil cytoplasmic antibody (p-ANCA) marks an etiological division between stress-susceptible and stress-neutral ulcerative colitis. Subjects were 47 UC patients with known p-ANCA status (19 p-ANCA-positive, 28 p-ANCA-absent). Controls were 77 university students. Subjects and controls completed the Reciprocal Attachment Questionnaire. Subjects were categorized as avoidant/nonavoidant and anxious/nonanxious based on scores for compulsive self-reliance and compulsive care seeking, respectively. A higher prevalence of avoidant attachment was present in p-ANCA-absent (58.6%) than p-ANCA-positive subjects (22.2%, chi-square = 5.95, P < 0.02). There was no difference in the prevalence of anxious attachment between p-ANCA-absent and p-ANCA-positive subjects. There was no difference in clinical and psychiatric variables between groups. This finding provides support for a psychobiological contribution to UC in a subgroup identified by the absence of p-ANCA.     

Anti-<Emphasis Type="Italic">Saccharomyces cerevisiae</Emphasis> Antibody Does Not Differentiate Between Crohn's Disease and Intestinal Tuberculosis

The clinical, morphological, and histological features of intestinal tuberculosis (IT) and Crohn's disease (CD) mimic so much, that it becomes difficult to differentiate between them. The sensitivity of anti-Saccharomyces cerevisiae antibody (ASCA) IgG and ASCA IgA in CD is 60%-80%, whereas the specificity is almost 90%. There are no reports of study of ASCA in patients with IT, nor has it ever been used to differentiate CD from IT. Patients with ulcerative colitis (UC; n=25), CD (n=59), and IT (n=30) and 21 healthy controls were included in this study. The location and behavior of CD were classified according to the Modified Montreal classification. Five milliliters of blood was taken from them and serum was stored at -70 degrees C. ASCA antibodies (both IgG and IgA) were estimated using commercially available ELISA kits (AESKU Diagnostics, Germany). Anti-neutrophilic cytoplasmic antibody was measured by indirect immunofluorescence test. ASCA IgA was positive in 4.7%, 28%, 33.9%, and 43.3% and ASCA IgG was positive in 4.7%, 24%, 50.8%, and 46.6% of healthy controls and patients with UC, CD, and IT, respectively. Either ASCA IgG or ASCA IgA was positive in 9.5%, 40%, 61% and 66.6% of healthy controls, UC, CD, and IT, respectively. ANCA was positive in 0%, 32%, 10.1%, and 6.6% of healthy controls, UC, CD, and IT, respectively. ASCA IgG was positive in a significantly higher number of patients with CD (P<0.0001) and IT (P<0.0001) in comparison to healthy controls. ASCA IgA was positive in a significantly higher number of patients with UC (P<0.04), CD (P<0.013), and IT (P<0.006) in comparison to healthy controls. In comparisons between diseases, ASCA IgG was positive in significantly more patients with CD (P<0.001) and IT (P<0.001) in comparison to UC. There was no significant difference in ASCA IgA (33.9% vs. 43.3%), ASCA IgG (50.86% vs. 46.6%), or ANCA (10.7%, 7.4%) in patients with CD and IT, respectively. There was no correlation between ASCA and duration, location and behavior of CD, and IT. We conclude that ASCA IgG and ASCA IgA do not help to differentiate between IT and CD.     

结核抗体lgG/lgM检测在肺结核和肺外结核中的诊断价值

目的 探讨异种血清抗体检测技术在结核病诊断中的应用价值。方法 采用IgG/IgM抗体试剂盒分别检测102例结核病患者(包括73例肺结核和29例肺外结核)、223例其他肺部疾病患者和100例对照者结核感染情况,以临床诊断为标准评价该方法的敏感度和特异性,同时分别与痰菌培养及痰涂片平行检验的结果作比较,统计学分析采用χ²检验。结果 结核抗体IgG/IgM检测结核病患者的敏感度为74.51%、特异度为91.64%。结核抗体IgG/IgM检测肺结核和肺外结核的敏感度分别为82.19%、55.17%,肺内和肺外结核的敏感度差异有统计学意义(P＜0.05),结核抗体lgG/IgM检测结核患者阳性检出率明显高于痰培养法和痰涂片法(P<0.05)。102例结核病患者年龄段分组分析,少年组和老年组检出率分别为58.33%、36%,远低于青年组和中年组的96.15%和89.74%。不同年龄组间进行卡方比较分析显示,P＜0.05,差异有统计学意义。425例标本中,共发现8例非结核分枝杆菌,其中6例胞内分枝杆菌, 2例脓肿分枝杆菌,lgG/lgM抗体检测均为阴性。结论 IgG/IgM血清抗体检测肺内、外结核具有快速方便、经济和较高的敏感度,适合用于临床结核筛查。     

核周型抗中性粒细胞胞浆抗体在溃疡性结肠炎诊断中的意义

目的了解血清中核周型抗中性粒细胞胞浆抗体(pANCA)对溃疡性结肠炎诊断的敏感性及特异性。方法本文采用间接免疫荧光法对我院51例溃疡性结肠炎、15例克罗恩病、30例对照患者血清中核周型抗中性粒细胞胞浆抗体进行检测。结果 51例溃疡性结肠炎患者中32例核周型抗中性粒细胞胞浆抗体阳性,其敏感性及特异性分别为62.75%及95.56%。15例克罗恩病患者中有2例阳性核周型抗中性粒细胞胞浆抗体阳性,阳性率为13.33%,30例对照组未发现核周型抗中性粒细胞胞浆抗体阳性患者,组间差异具有统计学意义(P<0.05)。结论血清中抗中性粒细胞胞浆抗体对溃疡性结肠炎具有一定的敏感性及高度的特异性,对其检测有利于溃疡性结肠炎的诊断及鉴别诊断。     

慢性腹泻患者食物特异性IgG抗体的检测

目的探讨食物不耐受与慢性腹泻发病的相关性。方法采用ELISA半定量法检测82例慢性腹泻患者血清中14种食物的水平。结果慢性腹泻患者所测食物中以蟹的IgG抗体阳性率（48．8％）最高，其次为虾（41．5％）、蛋清／蛋黄（35．4％）和牛奶（23．2％），再次为鳕鱼（19．5％）和小麦（17．1％）；≤50岁年龄组腹泻患者食物IgG抗体阳性率明显高于〉50岁年龄组（P〈0．05）；慢性腹泻患者食物特异性IgG抗体检测的总阳性率为89．0％（73／82），其中1种食物IgG抗体阳性率为30．5％（25／82），2种以上者为58．5％（48／82）。结论食物不耐受是慢性腹泻的致病因素之一，检测食物特异性IgG抗体对于了解慢性腹泻的发病机制和指导临床治疗具有积极的意义。     

Association of the HLA-DRB1＊0701 allele with perinuclear anti-neutrophil cytoplasmatic antibodies in Mexican patients with severe ulcerative colitis

AIM: To determine the association between the HLADRB1 alleles and perinuclear anti-neutrophil cytoplasmatic antibodies (p-ANCA) positive in Mexican patients with ulcerative colitis (DC). METHODS: Ninety Mexican mestizo patients (45 females) with DC, confirmed by biopsy, were studied. High resolution HLA typing was performed by PCR-SSO reverse dot blot and PCR-SSP. Molecular typing techniques were applied to define HLA-DRB1 alleles. Enzyme-linked immunosorbent assay and immunofluorescence techniques were used to detect p-ANCA. RESULTS: Forty-eight (53%) UC patients were positive for p-ANCA by ELISA and IF. We found that p-ANCA-positive UC patients had a significantly increased frequency of HLA-DR7 compared with p-ANCA-negative controls (22% vs 5.1%; pC = 0.02, OR = 5.2, CI 95%: 1.06-37.82). Disease activity was scored as severe in 20 patients, moderate in 8, mild in 14 and no activity in the remaining 38 patients according to the Truelove and Witts criteria. Subgroup analysis showed a significantly increased frequency of the HLA-DRB1*07 allele in 15 of 20 UC patients with severe activity of UC and p-ANCA positivity [100% vs 0%; pC = 0.0000001; OR = 35]. No significant differences were found between p-ANCA positive patients, HLA-DR alleles and other clinical features such as extraintestinal manifestations, proctocolectomy and extension. CONCLUSION: The HLA-DRB1*07 is associated with p-ANCA positive UC Mexican patients.     

Antineutrophil cytoplasmic antibodies in Japanese patients with inflammatory bowel disease: prevalence and recognition of putative antigens

OBJECTIVE: Our aim was to investigate the prevalence of antineutrophil cytoplasmic antibodies (ANCA) in Japanese patients with ulcerative colitis (UC) and Crohn's disease (CD), and the putative antigens recognized by perinuclear staining pattern ANCA (p-ANCA)-positive sera. METHODS: Sera from UC (n = 52) and CD (n = 43) patients, and from healthy controls (n = 74) were studied. The indirect immunofluorescence (IIF) method was used for the detection of ANCA and its binding pattern. p-ANCA-positive sera were studied further for putative antigens. ELISAs using lactoferrin (Lf), myeloperoxidase (MPO), and cathepsin G (Cat G) as antigens were performed. RESULTS: ANCA was positive in 40 of the 52 (76.9%) UC (p-ANCA in 33) and in 32 of the 43 (74.4%) CD (p-ANCA in 31) patients. UC and CD patients showed significantly higher titers of p-ANCA than controls; however, no significant difference was observed between UC and CD. In UC, 23, 17, and nine of the 33 patients with p-ANCA-positive sera showed reactivity with Lf, MPO, and Cat-G, respectively. In CD, 21, 20, and 11 of the 31 patients with p-ANCA-positive sera showed reactivity with Lf, MPO, and Cat-G, respectively. Fourteen of the UC and six of the CD patients showed reactivity with two different antigens, and seven of the UC and 11 of the CD patients showed reactivity with all three antigens. The presence of anti-Lf and anti-MPO antibodies was further confirmed by Western blotting. CONCLUSIONS: ANCA is useful in distinguishing patients with IBD from normal subjects but is not sufficient for the differential diagnosis of CD and UC. p-ANCA reactivity might be derived from the recognition of heterogeneous neutrophil-associated antigens.     

抗HK-1抗体及抗KLHL12抗体评估原发性胆汁性胆管炎患者对熊去氧胆酸应答的研究

目的:探讨抗HK-1抗体和抗KLHL12抗体评估原发性胆汁性胆管炎（PBC）患者对熊去氧胆酸（ursodeoxycholic acid,UDCA）应答的价值。方法:分析经UDCA治疗12个月以上并且资料相对完整的112例PBC患者,收集其血清,ELISA检测患者血清中的抗线粒体抗体（AMA）、抗HK-1抗体和抗KLHL...