联合多种自身抗体检测对炎症性肠病的诊断价值研究

目的:联合检测核周型抗中性粒细胞胞浆抗体(pANCA)、抗酿酒酵母菌抗体(ASCA)、抗胰外分泌腺抗体(PAB)和抗小肠杯状细胞抗体(GAB)在炎症性肠病(IBD)中的表达,以探讨其对炎症性肠病中的克罗恩病(CD)和溃疡性结肠炎(UC)的诊断与鉴别诊断价值。方法:空腹采集静脉血2ml,用间接免疫荧光法测定113例UC组、96例CD组、43例肠道疾病对照组及20例正常对照组血清pANCA、ASCA、PAB、GAB的表达。结果:在4个组中,UC组的pANCA阳性率为40.7%,明显高于其他3组(P0.01)。ASCA在UC组与CD组的阳性率分别为5.3%和4.2%,2组之间及与疾病对照组、正常对照组比较均无显著性差异(P0.05)。GAB在UC组及CD组的阳性率分别为13.3%和12.5%,2组比较差异无显著性意义(P0.05),与疾病对照组及正常对照组比较差异有显著性意义(P0.05)。PAB各组无一例阳性。联合检测4种抗体诊断IBD的敏感性、特异性和阳性阴性预测值分别为41.6%、96.8%、97.8%和33.3%。pANCA+/ASCA-诊断UC的敏感性和特异性为40.7%和96.8%,pANCA-/GAB+诊断CD的敏感性和特异性为11.5%和100%。结论:炎症性肠病相关抗体检测的特异性高,但敏感性低,联合检测能显著提高敏感性。pANCA对UC的诊断和鉴别诊断有意义,GAB对IBD的诊断较有意义,而ASCA和PAB对IBD的诊断价值不大。联合检测pANCA和GAB,可用于UC和CD的鉴别诊断。     

抗酿酒酵母抗体和抗中性粒细胞胞质抗体对炎症性肠病的诊断价值

目的 了解抗酿酒酵母抗体(ASCA)和核周型抗中性粒细胞胞质抗体(pANCA)的分布,观察其在炎症性肠病(IBD)诊断及鉴别诊断中的意义.方法 选择2002年9月至2007年7月在北京协和医院就诊并行ASCA、pANCA检查的IBD患者175例,其中克罗恩病(CD)62例、溃疡性结肠炎(UC)97例、未定型16例.另取对照者167例.采用酶联免疫吸附法测定血清ASCA水平,间接免疫荧光法测定血清pANCA水平.结果 在CD、UC、未定型者、对照者中,ASCA的阳性率分别为45.2%、14.4%、11/16、29.3%,pANCA的阳性率分别为4.8%、56.7 0A、1/16、4.8%.对照者中,ASCA在恶性肿瘤、嗜酸性粒细胞增多症、自身免疫性肝病、弥漫性结缔组织病及肠结核中的阳性率较高(分别为42.1%、2/5、4/10、4/19、4/14).ASCA诊断CD的敏感性、特异性及阳性预测值分别为45.2%、85.6%、66.7%.pANCA诊断UC的敏感性、特异性及阳性预测值分别为56.7%、95.2%、94.8%.联合检测ASCA+/pANCA-诊断CD的敏感性、特异性及阳性预测值分别为41.9%、93.8%,81.3%.联合检测ASCA-/pANCA+诊断UC的敏感性、特异性和阳性预测值分别为48.5%、98.4%、97.9%.结论 ASCA和pANCA不适于作为IBD筛查指标,联合检测有利于UC与CD的鉴别诊断.     

核周型抗中性粒细胞胞质抗体和抗酿酒酵母抗体在炎症性肠病中的临床意义

核周型抗中性粒细胞胞质抗体（pANCA）和抗酿酒酵母抗体（ASCA）是一组与炎症性肠病（IBD）密切相关的免疫球蛋白,但对溃疡性结肠炎（UC）、克罗恩病（CD）的诊断和鉴别诊断的价值仍有待进一步验证。目的：探讨pANCA和ASCA在UC与CD诊断和鉴别诊断中的意义。方法：以酶联免疫吸附测定（ELISA）检测64例UC、62例CD和56例健康对照者的血清pANCA、ASCA水平和阳性率,分析pANCA、ASCA及其组合的诊断敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）。结果：UC组血清pANCA水平[（584．22±347．70）pg/ml对（304．99±211．10）pg／ml和（390．92±82．82）pg/ml,P〈0．01]和阳性率（50．0％对14．5％和14.3％,P〈0．01）显著高于CD组和健康对照组,三组间血清ASCA水平和阳性率无明显差异。pANCA^＋和pANCA^＋/ASCA-诊断UC的敏感性、特异性、PPV和NPV分别为50．0％、85．7％、80．0％、60．0％和42．2％、89.3％、81．8％、57．5％,ASCA^＋和ASCA^＋／pANCA^-诊断CD的敏感性、特异性、PPV和NPV分别为8．1％、87．5％、41．7％、46.2％和3.2％、91．1％、28．6％、45．9％。结论：pANCA阳性有利于UC的诊断。pANCA／ASCA联合检测有助于鉴别UC,但对CD诊断价值不高。     

抗酿酒酵母菌和中性粒细胞胞浆抗体联合测定鉴别炎症性肠病的意义

目的　联合测定血清抗酿酒酵母菌抗体 (ASCA) IgG、ASCA IgA和核周型抗中性粒细胞胞浆抗体 (pANCA)水平 ,探索其对克罗恩病 (CD)和溃疡性结肠炎 (UC)的诊断和鉴别诊断意义。 方法　分别应用标准化ELISA法和间接免疫荧光法对 19例炎症性肠病 (IBD ,UC10例 ,CD9例 )患者和 18名健康对照者血清ASCA IgG、ASCA IgA和pANCA水平进行测定。 结果　 9例CD患者 (末段回肠和结肠均累及 )血清ASCA IgG和ASCA IgA水平 (酶单位 )分别为18.5 1± 6 .38和 11.74± 5 .4 6 ,显著高于10例UC患者 (6 .98± 5 .2 4和 3.88± 3.5 2 )和 18名健康对照者 (5 .90± 4 .12和 4 .6 2± 3.2 1,P值均 <0 .0 5 ) ,pANCA诊断UC的敏感性为 80 % ,而CD患者和健康对照者的阳性检测率均为 0 %。结论　AS CA是一种对CD具有特异性的抗体 ,pANCA是与UC显著正相关的一个免疫学指标。它们均有助于CD与UC的诊断和鉴别诊断 ,是IBD非创伤性鉴别诊断方法之一。     

炎症性肠病血清学抗体的临床意义

背景:对于炎症性肠病(IBD),迄今尚无疾病诊断和监测的金标准。鉴于免疫系统在IBD发病中的重要作用,检测血清免疫特异性抗体水平对于IBD的诊断和鉴别诊断可能有一定价值。目的:探讨血清抗酿酒酵母抗体(ASCA)和核周型抗中性粒细胞胞质抗体(pANCA)在IBD中的临床意义。方法:连续纳入2015年2月—2016年5月苏州大学附属第一医院收治的IBD患者91例,其中克罗恩病(CD)52例,溃疡性结肠炎(UC)39例,36例排除IBD的胃肠道疾病患者作为对照组。分别采用ELISA法和间接免疫荧光法检测血清ASCA-IgG、IgA和pANCA。以临床诊断为金标准,采用四格表对ASCA、pANCA进行诊断试验评价;采用ROC曲线、Pearsonχ2检验、Fisher精确检验分析两种血清学抗体与IBD、CD、UC以及病变部位的关系。结果:血清ASCA-IgG和IgA均与CD相关(AUC=0.626和0.614),而UC仅与ASCA-IgA相关(AUC=0.486)。血清pANCA与IBD(r=0.342)、CD(r=-0.262)、UC(r=0.614)均相关,对IBD和UC的诊断敏感性和特异性优于CD(P0.05)。CD患者的ASCA-IgG与病变累及回肠末端相关(P0.05),pANCA与病变累及结肠相关(P0.05);UC患者的ASCA-IgG、IgA均与病变累及回肠末端相关(P0.05)。结论:血清ASCA、pANCA有助于在IBD诊断确立的基础上区分CD与UC,并可能对病变部位具有提示作用。ASCA可能与病变累及回肠末端相关,而pANCA则可能与病变累及结肠相关。     

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.     

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...     

溃疡性结肠炎患者食物不耐受及血清学标记物相关性分析

目的分析本组溃疡性结肠炎(UC)患者血清食物特异性IgG抗体与UC的相关性及与p-ANCA、GAB的可能相关性。方法按照《中国炎症性肠病诊断治疗规范的共识意见》,对59例UC患者及52例对照组患者进行血清p-ANCA、GAB及食物特异性IgG抗体检测。结果 59例UC患者中,出现食物特异性抗体IgG者51例,阳性率为86.44%。与对照组阳性率比较,差异有统计学意义(P<0.05)。不同病变范围的食物特异性抗体IgG阳性率差异无统计学意义(P>0.05)。p-ANCA阳性时出现食物不耐受的阳性率明显高于GAB阳性时,差异有统计学意义(P<0.05)。结论食物不耐受与UC发生发展存在一定的关联,但与病变部位不相关。p-ANCA阳性的患者多存在食物不耐受。     

ANCA、ASCA血清学检测与炎症性肠病

炎症性肠病（inflammatory bowel disease，IBD）是指原因不明的一组非特异性肠道炎症，包括溃疡性结肠炎（ulcerative colitis，UC）和克岁恩病（Crohn’s disease，CD）。目前，对IBD的诊断是在综合临床表现、实验室和放射学检查、内镜及病理学检查，并存排除各种其他原因引起的肠道炎症基础上做出的。由于机体免疫系统在IBD的发病机制中发挥重要作用。近年来关于血清免疫特异性抗体标记物的研究较多，这些抗体包括核周型抗中性粒细胞抗体（pANCA）、抗酿酒酵母抗体（ASCA）、抗胰外分泌腺抗体、大肠埃希氏菌外膜孔道蛋白C、I2抗体等，这些抗体的检测可能在IBD的诊断、活动度、分层以及对治疗的反应方面都有作用。     

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。     

Anti-Saccharomyces cerevisiae mannan antibodies and antineutrophil cytoplasmic autoantibodies in Greek patients with inflammatory bowel disease

OBJECTIVES: The combined measurement of perinuclear antineutrophil cytoplasmic autoantibodies (pANCA) and anti-Saccharomyces cerevisiae mannan antibodies (ASCA) has recently been suggested as a valuable diagnostic approach in inflammatory bowel disease (IBD). The aim of this study was to assess the value of detecting pANCA and ASCA in the differentiation between ulcerative colitis (UC) and Crohn's disease (CD) in a Greek population with IBD. METHODS: Sera were collected from 157 patients with IBD (97 with UC, 56 with CD, and four with indeterminate colitis) and 150 healthy controls. Determination of pANCA was performed by a standard indirect immunofluorescence technique on ethanol-fixed granulocytes and ASCA by an ELISA assay. RESULTS: In patients with UC, sensitivity, specificity, positive predictive value, and negative predictive value of the pANCA test was 67%, 84%, 93%, and 46% respectively. These values did not change significantly when the combination of positive pANCA and negative ASCA was used. ASCA test in diagnosing CD yielded a sensitivity, specificity, positive predictive value, and negative predictive value of 39%, 89%, 54%, and 81%. The combination of pANCA negative and ASCA positive increased the positive predictive value to 77% and it was associated with small bowel disease. CONCLUSIONS: A positive pANCA test in Greek patients has a diagnostic value in confirming a diagnosis of UC. Measurement of pANCA and ASCA together has a rather limited value in the differential diagnosis between UC and CD but may be of help in studying disease heterogeneity.     

A comparative study of goblet cell and pancreatic exocine autoantibodies combined with ASCA and pANCA in Chinese and Caucasian patients with IBD

BACKGROUND: The incidence of Crohn's disease (CD) and ulcerative colitis (UC) is increasing, but differentiating between them is often extremely difficult. Pancreatic (PAB) and goblet cell autoantibodies (GAB) are specific for CD and UC, respectively, but with low sensitivity. In combination with anti-Saccharomyces cerevisiae (ASCA) and anti-neutrophil cytoplasmic antibodies (pANCA) testing, these antibodies may improve differentiation between the diseases. This study determined the sensitivity, specificity, and positive and negative predictive values (PPV and NPV) of PAB and GAB +/- ASCA and pANCA testing in Chinese and Caucasian IBD populations. RESULTS: Patients were recruited from Caucasian and Chinese populations (CD, n = 100; UC, n = 99; controls, n = 100). PAB was highly specific for CD, and detection was greater in patients less than 35 years old and in Chinese compared with Caucasian patients with CD (CD, 46% versus 22%, P = 0.018; UC, 2% versus 6%; controls, 0% versus 2%). GAB detection was poor in all groups (<2%). PAB showed a PPV of 93% to differentiate all patients with CD from patients with UC, but only 62% for those with isolated colonic disease. The PPV of PAB increased to 100%, specificity was 100%, and sensitivity was 21% for isolated colonic disease when combined with pANCA and ASCA. PAB expression was not associated with stricturing or perforating CD. CONCLUSIONS: This study identified that GAB was not useful in our patients with IBD. PAB expression was highly specific for CD and more sensitive in Chinese than Caucasian patients with CD. The combination of PAB, pANCA, and ASCA testing improved the differentiation between UC and CD, particularly in isolated colonic disease, compared with pANCA and ASCA testing alone.     

pANCA and ASCA in the diagnosis of different subtypes of inflammatory bowel disease

BACKGROUND/AIMS: The measurement of perinuclear antineutrophil cytoplasmic (pANCA) and anti-Saccharomyces cerevisiae antibodies (ASCA) has recently been suggested as a valuable and noninvasive diagnostic approach in the differentiation of ulcerative colitis (UC), Crohn's disease (CD) and indeterminate colitis (IC). The aim of the study was to determine the prevalence of pANCA and ASCA in patients with inflammatory bowel disease (IBD) subgroups of different clinical course and to assess their accuracy in differential diagnosis. METHODOLOGY: The study was performed in 109 patients: 50 patients with UC, 17 with CD, 18 with IC and 24 non-IBD controls. Antibodies status has been measured with ELISA, using commercial antibody panel by MedTek kits, confirmed by IIF technique using Euroimmun panels. RESULTS: Sensitivity and specificity of pANCA+/ ASCA- pattern for UC diagnosis was 36% and 98%; pANCA-/ASCA+ for CD: 35% and 88%, pANCA/ASCA- for IC: 72% and 63%, respectively. In addition the significant positive correlation between antibodies profiles: pANCA+/ASCA- and active disease; pANCA-/ASCA+ and number of operations, as well as the negative correlation between pANCA-/ASCA- and patient's age has been found. CONCLUSIONS: Our study lends further support to the opinions that serologic assessment identifies a large subset of different subtypes of IBD patients.     

Discriminating IBD from IBS: comparison of the test performance of fecal markers, blood leukocytes, CRP, and IBD antibodies

BACKGROUND: Symptoms of inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS) can overlap. We aimed to determine the accuracy of fecal markers, C-reactive protein (CRP), blood leukocytes, and antibody panels for discriminating IBD from IBS and to define a "best test." METHODS: We prospectively included 64 patients with IBD (36 Crohn's disease [CD], 28 ulcerative colitis [UC]), 30 with IBS, and 42 healthy controls. Besides CRP and blood leukocytes, blinded fecal samples were measured for calprotectin (PhiCal Test, enzyme-linked immunosorbent assay [ELISA]), lactoferrin (IBD-SCAN, ELISA), Hexagon-OBTI (immunochromatographic test for detection of human hemoglobin), and LEUKO-TEST (lactoferrin latex-agglutination test). Blinded serum samples were measured for the antibodies ASCA (ELISA) and pANCA (immunofluorescence). RESULTS: Overall accuracy of tests for discriminating IBD from IBS: IBD-SCAN 90%, PhiCal Test 89%, LEUKO-TEST 78%, Hexagon-OBTI 74%, CRP 73%, blood leukocytes 63%, CD antibodies (ASCA+/pANCA- or ASCA+/pANCA+) 55%, UC antibodies (pANCA+/ASCA-) 49%. ASCA and pANCA had an accuracy of 78% for detecting CD and 75% for detecting UC, respectively. The overall accuracy of IBD-SCAN and PhiCal Test combined with ASCA/pANCA for discriminating IBD from IBS was 92% and 91%, respectively. CONCLUSIONS: The PhiCal Test and IBD-SCAN are highly accurate for discriminating IBD from IBS. There is only marginal additional diagnostic accuracy when the PhiCal Test and IBD-SCAN are combined with ASCA and pANCA. ASCA and pANCA have a high specificity for IBD.     

A prospective comparative study of ASCA and pANCA in Chinese and Caucasian IBD patients

BACKGROUND: Inflammatory bowel disease manifests throughout all ethnic groups. Antisaccharomyces cerevisiae (ASCA) and antineutrophil cytoplasmic antibodies (pANCA) can aid in the differentiation between Crohn's disease (CD) and ulcerative colitis (UC), but their sensitivity may vary between races. OBJECTIVES: This study compared the sensitivity, specificity, and positive and negative predictive values (PPV, NPV) of pANCA and ASCA between Chinese and Caucasian IBD populations and identified disease subtype associations. RESULTS: Three hundred patients were prospectively recruited from Caucasian and Chinese populations (CD, n = 50, UC, n = 50, controls, n = 50 each). pANCA detection was greater in Caucasian than Chinese UC patients (p= 0.046). ASCA IgG detection was similar, but IgA was lower in Chinese CD patients (p < 0.001). Differentiation between UC and CD (+ve pANCA/-ve ASCA) demonstrated a PPV of 92% in isolated colonic disease. Logistic regression in CD identified positive pANCA had a lower association with ileal (OR = 6.8, p= 0.0067) and complicated disease (OR = 5.5, p= 0.015). Caucasian CD patients with positive ASCA IgA/IgG had a greater association with ileal (OR = 6.7, p= 0.022) or complicated disease (OR = 9.4, p= 0.0073) and in Chinese CD patients positive ASCA IgA/IgG was associated with isolated ileal disease (OR = 16.8, p= 0.032). Linear regression demonstrated that higher ASCA titers predicted complicated CD and isolated ileal disease. CONCLUSIONS: This study identified that pANCA is more sensitive in Caucasian than Chinese UC and that ASCA IgA has a low yield in Chinese CD. pANCA and ASCA are useful for differentiating between UC and CD in both populations, and ASCA IgG and IgA titers have potential use in determining the risk of developing complicated CD.     

Serological markers in diagnosis of pediatric inflammatory bowel disease and as predictors for early tumor necrosis factor blocker therapy

Objective: To describe the prevalence of serological markers in newly diagnosed treatment-naïve pediatric inflammatory bowel disease (IBD), their utility in differentiating Crohn’s disease (CD), ulcerative colitis (UC) and symptomatic non-IBD patients and whether serological markers are associated with early TNF blocker treatment.

Material and methods: Ninety-six children and adolescents <18 years, 58 with IBD and 38 symptomatic non-IBD controls were included. At diagnosis and after 1–2 years, serological antibodies (anti-Saccharomyces cerevisiae antibodies (ASCA), perinuclear anti-neutrophil cytoplasmic antibody (pANCA), flagellin expressed by Clostridial phylum (anti-CBir1), outer membrane porin of Escherichia coli (anti-OmpC), Pseudomonas fluorescens-associated sequence (anti-I2), CRP, ESR and fecal calprotectin were analyzed. The choice of treatment was made at the discretion of the treating pediatrician.

Results: Of the IBD patients, 20 (36%) and 26 (47%) were positive for ASCA and pANCA compared to 3(8%), p?<?.01 and 10 (27%), p?=?.04 of the controls. Thirteen (72%) of UC patients were pANCA positive, versus 13 (35%) of CD patients (p?<?.01). None of the UC patients was ASCA positive versus 20 (54%) of CD patients (p?<?.0001). Compared to conventionally treated patients, the 18 (49%) TNF blocker treated CD patients had higher presence of ASCA (p?<?.01), lower presence of pANCA (p?=?.02) and higher levels of fecal calprotectin, CRP and ESR at diagnosis. In multivariate analyses ASCA and pANCA status, but not CRP, ESR or calprotectin, were independently associated with early TNF blocker treatment.

Conclusions: ASCA and pANCA status were associated with having IBD and with early TNF blocker treatment in CD.     

Diagnostic value of anti-Saccharomyces cerevisiae and antineutrophil cytoplasmic autoantibodies in inflammatory bowel disease

OBJECTIVES: Correct diagnosis of inflammatory bowel disease (IBD), especially the differentiation between Crohn's disease (CD) and ulcerative colitis (UC), is highly important toward treatment and prognosis. Serological markers are noninvasive diagnostic tools that could be of value in differentiating CD from UC, in cases of indeterminate colitis, and in the identification of subgroups in IBD. The aim of this study was to evaluate the diagnostic accuracy of perinuclear antineutrophil cytoplasmic (pANCA) and anti-Saccharomyces cerevisiae antibodies (ASCA) for IBD. METHODS: ASCA and pANCA were studied in a large cohort of consecutive IBD patients (n = 582: 407 CD, 147 UC, and 28 indeterminate colitis), patients with non-IBD diarrheal illnesses (n = 74), and healthy controls (n = 157). An indirect immunofluorescence technique and a standardized ELISA were performed for detection of pANCA and ASCA, respectively. RESULTS: Prevalence of ASCA and pANCA was high in CD patients (59.7%) and UC (49.7%) patients, respectively. Positivity for both markers was significantly lower in healthy and non-IBD controls. Accuracy data (sensitivity, specificity, PPV, and NPV, respectively) for differentiating IBD from controls are as follows: ASCA+: 60% (243/407), 91% (345/378), 88% (243/276), and 68% (345/509); pANCA+: 50% (73/147), 95% (605/638), 69% (73/106), and 89% (605/679); ASCA+/pANCA-: 56% (229/407), 94% (355/378), 91% (229/252), and 67% (355/533); and pANCA+/ASCA-: 44% (65/147), 97% (620/638), 78% (65/83), and 88% (620/702). CONCLUSIONS: Specificity of serological markers for IBD is high, but low sensitivity makes them less useful as diagnostic tests. The combination of tests is probably more powerful, although, clinical subgroups still need to be defined. The usefulness of these markers in indeterminate colitis needs to be studied prospectively.     

Anti-Saccharomyces cerevisiae and antineutrophil cytoplasmic antibodies as predictors of inflammatory bowel disease

BACKGROUND AND AIMS: Several antibodies have been reported in the sera of patients with Crohn's disease (CD) and ulcerative colitis (UC). The most commonly described are anti-Saccharomyces cerevisiae mannan antibodies (ASCA) in CD and perinuclear antineutrophil cytoplasm antibodies (pANCA) in UC. Familial clustering of these antibodies has been described, suggesting they might be genetic markers. Our aim was to investigate the presence of these antibodies before the emergence of overt clinical manifestations. METHODS: Since 1980, the Israeli Defense Force (IDF) Medical Corps Serum Repository has stored serum samples obtained systematically from 5% of all recruits on enlistment, and from the same population on discharge from compulsory military service. We evaluated serum samples obtained from 32 subjects with CD and eight with UC before they were clinically diagnosed, along with samples from matched controls. RESULTS: ASCA were present in 10/32 (31.3%) CD patients before clinical diagnosis compared with 0/95 (0%) controls (p<0.001). None of the eight patients with serum samples available before diagnosis of UC were ASCA positive. ASCA was positive in 54.5% of patients after diagnosis of CD. The mean interval between ASCA detection and diagnosis was 38 months. In 90% of patients, antibodies were detected in the first available serum sample; therefore, measurements of the average time from the presence of ASCA to diagnosis may be even longer. pANCA were present in 2/8 (25%) patients with available sera before the diagnosis of UC. None of their 24 matched controls were positive (p = 0.014). CONCLUSIONS: ASCA and pANCA may predict development of inflammatory bowel disease years before the disease is clinically diagnosed.