炎症性肠病患者血清中自身抗体检测的临床意义

目的研究抗酿酒酵母抗体(ASCA)和抗中性粒细胞胞浆抗体(pANCA)在炎症性肠病诊断与鉴别诊断中的意义。方法间接免疫荧光生物薄片法检测29例溃疡性结肠炎(UC)、34例克罗恩病(CD)及25例正常对照者血清中ASCA和pANCA的表达。结果pANCA在CD组、UC组和正常对照组中的阳性率分别为47.1%、69.0%和16.0%,UC组显著高于CD组(P<0.05)和正常对照组(P<0.05)。ASCA在上述3组中的阳性率分别为11.8%、58.6%和8.0%,UC组亦显著高于CD组(P<0.05)和正常对照组(P<0.05)。ASCA /pANCA-诊断CD的敏感性、特异性、阳性预测值分别是0、89.7%和0;pANCA /ASCA-诊断UC的敏感性、特异性和阳性预测值分别是20.7%、64.7%和33.3%。结论ASCA和pANCA阳性有利于炎症性肠病的诊断却不能敏感地筛选患者;ASCA和pANCA联合检测不能作为汉族UC和CD鉴别诊断的指标。

Diagnostic role of anti-saccharomyces cerevisiae and antineutrophil cytoplasmic autoantibodies in inflammatory bowel disease

OBJECTIVE: To determine the accuracy of the assay using perinuclear antineutrophil cytoplasmic antibody (pANCA) and anti-saccharomyces cerevisiae antibodies (ASCA) in diagnosing ulcerative colitis (UC) and Crohn's disease (CD) and whether the presence of ASCA and pANCA antibodies could differentiate either CD from UC, or inflammatory bowel disease (IBD) from normal controls. METHODS: Serum samples were obtained from 34 patients with CD and 29 with UC, and from 25 normal volunteers. Diagnosis was established on clinical findings, X-ray or endoscopy and histology. Determination of ASCA and pANCA antibodies was performed using indirect immunofluorescence technique. RESULTS: 47.1% patients with CD against 69.0% patients with UC expressed pANCA (P < 0.05). Vice versa 58.6% patients with UC against 11.8% patients with CD expressed ASCA (P < 0.05). The sensibility, specificity and positive predictive value of combination of positive ASCA and negative pANCA to diagnosis CD was 0, 89.7% and 0 respectively, and those of combination of positive pANCA and negative ASCA to diagnosis of UC was 20.7%, 64.7% and 33.3% respectively. CONCLUSIONS: The positive of either ASCA or pANCA are not enough sensible to screen the IBD, but useful to diagnosis IBD. The combination pANCA and ASCA can not be as a serum differential diagnosis marker for IBD.