血清ANCA与ASCA和GAB联合检测对炎症性肠病的临床意义

目的 抗中性粒细胞胞浆抗体(Antineutrophil Cytoplasmic Antibody,ANCA)、抗酿酒酵母抗体(Anti-Saccharomyces Cerevisiae Antibody,ASCA)与抗小肠杯状细胞抗体(Anti-small intestinal goblet cell antibody,GAB)在炎症性肠病中的诊断价值。方法 选择医院2014年1月-2017年12月收治的炎症性肠病(Inflammatory Bowel Disease,IBD)患者80例设为IBD组,45例溃疡性结肠炎(Ulcerative Colitis,UC)患者设为UC组,35例克罗思病(Crohn's disease,CD)患者设为CD组。50例非IBD患者设为疾病对照组,50名健康人设为健康对照组。酶联免疫吸附测定法检测各组受试者血清ASCA水平,间接免疫荧光法检测各组受试者血清ANCA、GAB水平。比较各组ANCA、ASCA、GAB的阳性率,及三者联合检测的阳性率。统计ANCA、ASCA、GAB及三者联合检测对IBD的诊断效能。结果 IBD组血清ANCA、ASCA、GAB阳性率均高于疾病对照组、健康对照组,差异有统计学意义(P<0.05)。IBD组血清ANCA、ASCA、GAB三者联合检测的阳性率高于ANCA、ASCA或GAB的单一检测,经比较差异均有统计学意义(P<0.05)。ANCA、ASCA、GAB及三者联合检测的准确度、敏感度、特异度、阴性预测值均高于ASCA、GAB单独检测,差异均有统计学意义(P<0.05)。结论 ANCA、ASCA、GAB三者联合检测有助于IBD的诊断,具有一定的临床价值。     

联合检测抗酿酒酵母菌抗体和中性粒细胞胞浆抗体在炎症性肠病中的临床意义

目的 联合检测抗酿酒酵母抗体(ASCA-IgG、IgA)和核周型抗中性粒细胞胞浆抗体(pANCA)水平,探索对克罗恩病(CD)和溃疡性结肠炎(UC)诊断和鉴别诊断的意义.方法 应用ELISA法和间接免疫荧光法检测9例CD,10例UC患者及18例健康对照组的ASCA-IgA及PANCA水平.结果 9例CD ASCA-IgG和ASCA-IgA水平(酶单位)为18.51±6.38和11.74±5.46,10例UC为6.98±5.24和3.88±3.52以及18名健康对照者5.90±4.12和4.26±3.21(P＜0.05).pANCA UC敏感性为80%,而CD和健康对照者阳性率为0%.结论 ASCA是一种对CD具有特异性的抗体,pASCA是与UC呈正相关的一个免疫学指标.     

50例类风湿关节炎患者血清抗中性粒细胞胞浆抗体的检测分析

目的：探讨血清抗中性粒细胞胞浆抗体（ANCA）在类风湿性关节炎（RA）发病中的作用。方法：采用间接免疫荧光法检测50例RA患者和50例正常对照的血清ANCA。结果：50例RA患者中，35例ANCA阳性，阳性率为70％，其中核周型（P—ANCA）21例，阳性率为42％，胞浆型（C—ANCA）14例，阳性率为28％；50例正常对照者无一例ANCA阳性。RA组与正常对照组比较，ANCA阳性率有显著性差异（P〈0．01）。结论：ANCA参与了类风湿性关节炎（RA）血管病变的发病机制，可作为RA的辅助诊断指标用于临床。     

抗中性粒细胞胞浆抗体的实验室检测

抗中性粒细胞胞浆抗体是一种以中性粒细胞和单核细胞胞浆成分为靶抗原的自身抗体.对系统性血管炎、炎症性肠病等多种疾病的诊断与鉴别具有重要意义.已成为自身免疫性疾病的一项非常重要的常规检测项目.检测ANCA的方法有多种,如:间接免疫荧光发、ELISA、免疫印迹法、欧蒙斑点法、欧蒙印迹法等.     

抗中性粒细胞胞浆抗体相关性血管炎的临床特点与治疗

[目的]分析抗中性粒细胞胞浆抗体(ANCA)相关性血管炎(AAV)的临床表现及治疗.[方法]对我院2005年4月～2010年4月收治的47例AAV患者的临床资料进行回顾性分析.[结果]本组47例患者中,38例(80.9%,38/47)环核型ANCA(pANCA)阳性,均识别髓过氧化物酶(MPO),8例(17.0%,8/47)胞浆型ANCA(cANCA)阳性,均识别蛋白酶3(PR3),1例cANCA及pANCA均阳性,同时识别MPO及PR3.6个月内确诊者27例(57.4%,27/47),6个月以上确诊者20例(42.6%,20/47).临床表现呈多器官受累,其中肾脏受累43例(91.5%,43/47),血肌酐升高36例(76.6%,35/47),肺脏受累30例(63.8%,30/47),咯血16例(34.0%,16/47).此外还有不同程度的消化系统、关节、肌肉、耳、眼、皮肤、神经系统、鼻等器官损害及非特异性表现.80%上患者有血沉增快、C反应蛋白升高及贫血.主要采用糖皮质激素联合环磷酰胺治疗,诱导缓解期总缓解率75.9%.[结论]抗中性粒细胞胞浆抗体(ANCA)相关性血管炎临床表现为多器官受累,ANCA检测有助于早期诊断.     

抗心磷脂抗体、抗中性粒细胞胞浆抗体和抗肾小球基底膜抗体联合检测在糖尿病肾病中的应用价值

目的探讨糖尿病肾病应用抗心磷脂抗体(ACLA)、抗中性粒细胞胞浆抗体(ANCA)和抗肾小球基底膜(GBM)抗体联合检测的价值。方法选取本院2016年3月-2018年11月收治的、符合纳入标准的糖尿病肾病患者60例作为研究组。同期选取71例健康体检者作为对照组。收集并分析2组患者胱抑素C、C-反应蛋白(CRP)、ACLA、ANCA、抗GBM抗体、微量白蛋白情况。结果研究组CRP、胱抑素C及微量白蛋白水平均高于对照组,差异有统计学意义(P<0.01);研究组ACLA、ANCA、抗GBM抗体的阳性率均高于对照组,差异有统计学意义(P<0.01);ACLA+ANCA+抗GBM抗体联合检测的敏感度、特异度、阳性预测值及阴性预测值均高于ACLA、ANCA及抗GBM抗体单项检测,差异有统计学意义(P<0.05)。结论ACLA、ANCA和抗GBM抗体联合检测可提高糖尿病肾病的诊断阳性率。     

丙基硫氧嘧啶与ANCA及相关血管炎

ANCA(antineutrophil cytoplasmic antibody)即抗中性粒细胞胞浆抗体,是针对中性粒细胞胞浆抗原的特异性抗体.通过经典的间接免疫荧光法可将ANCA分为两种构型:胞浆型(C-ANCA,cytoplasmic)和核周型(P-ANCA,perinuclear).     

原发性硬化性胆管炎15例临床分析

目的提高对原发性硬化性胆管炎(PSC)的认识和诊治水平。方法对15例原发性硬化性胆管炎的临床表现、实验室检查及诊治经过进行回顾性总结。结果临床表现为黄疸(100%)、发热(40%)、乏力(20%)、肝大(33·3%)、脾大(26·7%)、腹痛(66·7%)等,合并溃疡性结肠炎40%,肝功示AKP、GGT、胆红素均升高。4例抗核抗体(ANA)、2例抗平滑肌抗体(SMA)、1例抗中性粒细胞胞浆抗体(ANCA)阳性,7例肝穿刺活检及2例手术病理示非特异性炎症,15例经内窥镜逆行性胰胆管造影(ERCP)表现为肝内外胆管似枯枝样改变或串珠样改变。糖皮质激素、熊去氧胆酸、免疫抑制剂治疗有效。结论原发性硬化性胆管炎起病隐匿,临床、实验室检查及肝活检无特异性。ERCP为确诊首选方法。对于溃疡性结肠炎合并黄疸应警惕PSC。糖皮质激素、熊去氧胆酸、免疫抑制剂治疗有效。     

自身抗体检测在壮族人群系统性红斑狼疮诊断及病情发展中的意义

目的探讨自身抗体在壮族人群系统性红斑狼疮(SLE)诊断和病情发展中的意义。方法选取壮族SLE患者180例,疾病对照120例和健康对照120例,分别检测血清中抗核抗体(ANA)、抗中性粒细胞胞浆抗体(ANCA)、抗ENA抗体谱、抗C1q抗体、抗ds DNA抗体和抗心磷脂抗体(ACA),并探讨这些抗体与壮族SLE患者诊断、活动性、临床特征及实验室指标的关系。结果SLE组抗C1q、dsDNA、AnuA、ARPA、AHA、Sm、nRNP、ANCA、ACA抗体阳性率明显高于各对照组(P<0.01)。抗ds DNA、Sm抗体诊断特异性>90%。活动组抗C1q、dsDNA抗体水平及AnuA、ARPA、AHA、ANCA、ACA阳性率均高于非活动组(P<0.01)。这些抗体与肾脏损害、关节炎、24 h尿蛋白升高、白细胞减少、血红蛋白减少、血沉加快、补体C3/C4降低相关。结论抗C1q、dsDNA、AnuA、ARPA、AHA、Sm、nRNP、ANCA、ACA抗体是壮族人群SLE诊断的重要指标,与疾病活动及病情发展相关,在壮族人群SLE发病及病理过程中发挥极其重要的作用。     

抗中性粒细胞抗体在不完全川崎病早期诊断中的价值

目的探讨抗中性粒细胞抗体(Anti-Neutrophil Cytoplasmic Antiboby,ANCA)对不完川崎病(Incomplete Kawasaki Disease,IKD)的诊断价值。方法检测20例IKD患儿急性期和恢复期的ANCA,并检测急性期外周血象、C-反应蛋白(CRP)、血沉(ESR)及心脏彩超等。同期住院25例呼吸道感染患儿作为对照组。结果不完全川崎病组急性期血清ANCA阳性率明显高于对照组及恢复期,并显著高于并发冠脉病变的阳性率,ANCA阳性组急性期CRP值显著高于ANCA阴性组,而ESR、WBC、PLT无统计学差异(p>0.05)。结论检测ANCA有助于IKD患儿的早期诊断。     

炎症性肠病患者幽门螺杆菌感染情况及耐药性分析

目的分析炎症性肠病患者幽门螺杆菌感染情况与耐药性,为未来炎症性肠炎的诊治提供参考。方法选择南京医科大学附属常州市第二人民医院2017年2月-2019年2月胃肠外科或消化内科就诊治疗的初诊炎症性肠病患者120例,将120例炎症性肠病患者中86例溃疡性结肠炎纳为溃疡性结肠炎组,34例克罗恩病者纳为克罗恩病组,全部患者均接受胃肠镜检查及病理检查,抽取同期在医院接受常规体检的健康人群50名作为对照组,抽取入组者外周静脉血进行血培养,并对血培养结果为阳性者进行药敏试验,观察120例炎症性肠病患者幽门螺杆菌感染情况,对比三组入组者幽门螺杆菌感染率,分析并观察炎症性肠病患者幽门螺杆菌感染耐药情况,以年作为单位,对比2017年2月-2018年1月与2018年2月-2019年2月耐药率。结果120例患者中幽门螺杆菌感染共47例,感染率为39.17%,低于对照组的60.00%,差异有统计学意义(P<0.05);炎症性肠病幽门螺杆菌感染者对甲硝唑、克拉霉素、左氧氟沙星、莫西沙星均有不同程度耐药,但无完全耐药者;对阿莫西林、四环素、利福平、庆大霉素敏感性较高;2018年2月-2019年2月炎症性肠病患者幽门螺杆菌感染对克拉霉素、左氧氟沙星、莫西沙星的耐药率均较2017年2月-2018年1月升高,差异有统计学意义(P<0.05)。结论幽门螺杆菌感染可能是炎症性肠病发病的保护性因素,与疾病表型特征无相关性,菌株对常用抗菌药物的耐药率呈逐年升高趋势,这也是导致幽门螺杆菌根除率降低的主要原因,应引起临床重视。     

Evaluation of psychological disorders in Tunisian patients with inflammatory bowel disease. A comparative case-control study

AIM: To evaluate the psychological state in Tunisian patients with inflammatory bowel disease using the general health questionnaire in 12 items. METHODS: A prospective case-control study was performed, including 60 cases of Crohn's disease. 60 cases of ulcerative colitis and 60 healthy control subjects. The total score of the general health questionnaire was calculated on the basis of 0-0-1-1 system. RESULTS: The total score of the general health questionnaire was significantly higher in inflammatory bowel disease patients compared to control group (3.70+3,57 vs 0,16+ 0,52, p<0.0001). In inflammatory bowel disease patients, the total score of the general health questionnaire was significantly higher in Crohn's disease patients compared to ulcerative colitis patients (4,40+3,84 vs 3.01+3.18,p=0.03) and in case of active disease compared to quiescent disease (5,57+3.18 vs 1,64+2,78,p<0.0001). CONCLUSION: Psychological disorders are frequent in Tunisian patients with inflammatory bowel disease, essentially in patients with Crohn's disease or in case of active disease.     

Nonspecific inflammatory bowel disease and smoking

The authors assessed the relation between cigarette smoking and nonspecific inflammatory bowel disease in a case-control study of 124 cases of ulcerative colitis, 109 cases of Crohn's disease, and 250 age- and sex-matched control subjects in hospital for acute nongastric or intestinal conditions unrelated to smoking. For ulcerative colitis, the risk for current smoking compared with never smoking was 0.5, with a 95% confidence interval (Cl) of 0.3-1.0. They observed decreasing risk with increasing number of cigarettes smoked. The risk for ex-smokers, however, was greater than that for never smokers (relative risk = 2.7; 95% Cl = 1.5-4.9). The elevated risk of ulcerative colitis in ex-smoking in the presence of an overall lack of association with ever-smoking may plausibly be attributed to either 1) brief induction time of a protective effect of smoking on ulcerative colitis or 2) selective cessation of smoking due perhaps to very early symptoms of the disease. If time at first onset of bowel symptoms, instead of clinical diagnosis, is considered as the index date, the negative association between ulcerative colitis and current smoking would have weakened in men and disappeared in the overall series. There was clear evidence of a positive association between cigarette smoking and Crohn's disease (relative risk for ever smokers vs. never smokers = 4.0; 95% Cl = 2.2-7.3). The risk estimates increased with the number of cigarettes smoked per day and duration of habit. The association between current smoking and Crohn's disease was even stronger when age at first onset of bowel symptoms was considered as the index date, but the risk for ex-smokers fell below unity.     

Is there clustering of inflammatory bowel disease at birth?

Evidence points to possible cohort effects in inflammatory bowel disease, the possible role of perinatal infection as a risk factor for inflammatory bowel disease, and the occurrence of clusters of Crohn's disease. This evidence suggests the value of searching for birth date clustering among cases of inflammatory bowel disease. The authors looked for clustering by birth date and maternal residence at birth in a population-based series of 845 Crohn's disease patients and 1,330 ulcerative colitis patients born from 1924 through 1957 and diagnosed in the Uppsala Health Care Region, Sweden, until the end of 1983. Over this period, 43% of persons with Crohn's disease had been born within 6 days of another case, compared with 36% of controls simulated to account for monthly variation in births (p = 0.0002). The number of pairs of inflammatory bowel disease cases whose births occurred in the same county (close in space) and whose birth dates were also close in time was statistically significantly greater than expected for most birth dates 23-57 days apart. Results after 1944, when ascertainment was more complete, generally corroborate these findings and suggest some seasonality in the birth dates of ulcerative colitis cases. Results from the entire study period and after 1944 thus provide evidence for clustering by birth (including seasonality) among Crohn's disease cases and also, to a lesser extent, among ulcerative colitis cases.     

小儿炎症性肠病23例临床分析

目的了解小儿炎症性肠病（inflammatory bowel disease,IBD）的临床、实验室检查、影像学检查和内镜检查特点,以提高对小儿炎症性肠病的诊断水平。方法对1992年3月至2007年10月复旦大学附属儿科医院消化科收治的23例炎症性肠病患儿的临床资料进行回顾性分析。结果小儿炎症性肠病以男童发病为多,腹痛、腹泻、便血为溃疡性结肠炎（ulcerative colitis,UC）与克罗思病（Crohn’s disease,CD）的共同表现,而血便以溃疡性结肠炎多见,腹痛多见于Crohn’s病,肠外表现Crohn’s病更为多见。病变部位,溃疡性结肠炎以乙状结肠分布为主,Crohn’s病以末端回肠、回盲部分布为主,与成年人炎症性肠病相比,病变累及范围更广。结论需建立统一的小儿炎症性肠病活动指标,对炎症性肠病进行系统管理,尽早做出诊断,避免小儿生长发育迟缓。     

Small-area variations and sociodemographic correlates for the incidence of Crohn's disease and ulcerative colitis

The objectives of this study were to describe variations in the incidence of inflammatory bowel disease (IBD) within the Canadian province of Manitoba and to analyze sociodemographic factors associated with these variations. The authors used the Manitoba Health insurance databases to measure incidence rates of Crohn's disease and ulcerative colitis for each of 52 postal areas in Manitoba, in 1987-1996. The sociodemographic characteristics of the postal areas were based on data from the 1996 Canadian census. The overall incidence rates of Crohn's disease and ulcerative colitis were identical-15.6 per 100,000. Both diseases showed substantial geographic variation, with incidence rates differing significantly from the provincial average in 15 postal areas for Crohn's disease and in 13 postal areas for ulcerative colitis. There was a significant geographic correlation in the incidence of Crohn's disease and ulcerative colitis (r = 0.49, p < 0.001). The incidence of IBD was higher in urban areas (incidence rate ratio (IRR) = 1.21, 95% confidence interval (CI): 1.00, 1.45). Aboriginal Canadians had significantly lower rates of both Crohn's disease (IRR = 0.11, 95% CI: 0.05, 0.22) and ulcerative colitis (IRR = 0.57, 95% CI: 0.42, 0.79). A higher incidence of IBD was ecologically associated with a higher average family income, a lower proportion of immigrant and Aboriginal Canadian populations, and a smaller average family size.     

Inflammatory bowel diseases and lymphoma

The aims of this review are to precise the incidence of non-Hodgkin's lymphoma and Hodgkin's disease in inflammatory bowel disease and to assess the relationship between immunosuppressive therapy and lymphoma in inflammatory bowel disease. Population-based data show that incidence of lymphoma is not increased in patients with Crohn's disease or ulcerative colitis. There is an increased incidence of non-Hodgkin's lymphoma in inflammatory bowel disease patients on immunosuppressive therapy but overall risk is low in all cohort studies. Relationship between immunosuppression and lymphoma in inflammatory bowel disease is confirmed by frequency of cerebral lymphoma and association with Epstein-Barr virus.     

The uncertain primary diagnosis of inflammatory bowel diseases

BACKGROUND: The purpose of this study is to re-evaluate our series of patients affected by a colonic non-neoplastic disease, in order to measure the percentage in whom we were unable to make a correct diagnosis after the first clinical and histological approach and to single-out the reasons for our inability to reach the correct diagnosis. METHODS: During the period 1985-1999 we observed 1228 patients affected by chronic inflammatory colonic diseases. RESULTS: In 859 patients (69.9%) an ulcerative colitis was diagnosed for the first time, and 248 patients (20.1%) were affected by Crohn's colitis. One hundred and twenty-one patients (9.8%) were defined as being affected by an undetermined colitis. Forty-three patients of these had a definite diagnosis, afterwards: 27 patients were affected by ulcerative colitis and 16 by Crohn's colitis. Differential diagnosis between inflammatory large bowel diseases (ILBD) and other forms of colitis was set out as follows: 62 cases out of 1228 were consequent on a bacterial infection or parasitosis; in 28 patients a colitis pseudomembranosus was diagnosed. Eighteen cases of ischemic colitis are reported and 14 patients were affected by NSAID-related colitis. In another 6 patients we diagnosed a postradiation colitis. In 22 cases mimicking a Crohn's colitis we ascertained 9 patients affected by intestinal lymphoma, 11 mycobacterium tuberculosis related intestinal infections and 2 cytomegalovirus related colitis. CONCLUSIONS: Despite progress in scientific acquisitions and in diagnostic methods, correct initial diagnosis of ILBD is still difficult, even though it will be defined with time.     

Tracing colorectal carcinoma in patients with inflammatory bowel disease

In patients with ulcerative colitis the risk of colorectal cancer is increased. Based on a number of studies, British and American guidelines support endoscopic surveillance in these patients. As the cancer risk in ulcerative colitis increases with disease duration, it is recommended that surveillance is started 8-20 years after diagnosis depending on the extent of disease. Although previous studies have shown that the observed cancer risk in colonic Crohn's disease is unrelated to duration of disease, similar surveillance of these patients is suggested. A substantial number of cases of carcinoma in patients with inflammatory bowel disease present before scheduled onset of surveillance. Therefore, the optimal time of onset of surveillance is disputable. However, taking into account the relatively low risk of colorectal cancer in the early stages of inflammatory bowel disease, it will be hard to achieve an acceptable risk-benefit ratio of extending surveillance by starting surveillance colonoscopies at a younger age.     

Tobacco and inflammatory bowel disease

The relationship between tobacco and inflammatory bowel diseases is reported by many epidemiological studies. Smoking has a protective effect in ulcerative colitis. It delays the developing of the disease and improves the clinical pattern. Whereas smoking and passive smoking increase the risk of developing Crohn's disease. Tobacco is also a risk factor for severe symptoms, surgery and clinical relapses. The active substance was identified as nicotine. The major sites of nicotine effect are colonic mucus, intestinal permeability and cellular immunity. In practice, patients with Crohn's disease should stop smoking. Transdermal nicotine for ulcerative colitis could be effective.