抗中性粒细胞胞浆抗体对溃疡性结肠炎的诊断价值

目的　探讨抗中性粒细胞胞浆抗体 (ANCA)对溃疡性结肠炎 (UC)的诊断价值。方法　应用间接免疫荧光法 (IIF)、酶联免疫吸附法 (ELISA)和免疫印迹法 (Westernblot)分别对UC患者 ( 5 8例 )、非UC患者 ( 4 3例 )及健康献血员 ( 5 8例 )进行血清ANCA检测。结果　ANCA对UC诊断的敏感性为 3 7.93 % ,特异性为 10 0 %。UC患者中依据病情分为轻、中、重度组 ,ANCA的阳性率分别为17 65 %、4 1.67%和 5 2 .94 %。ANCA阳性肠黏膜炎症III～V级者占 78 95 % ,黏膜血管炎发生率为78 95 % ,而ANCA阴性者分别为 3 7.0 4 %和 4 4.4 4%。髓过氧化物酶 (MPO)、杀菌 /通透性增强蛋白(BPI)、乳铁蛋白 (LF)、组织蛋白酶G(CG)、蛋白酶 3 (PR 3 ) 5种ANCA抗原与UC患者血清的结合率分别为 13 .79%、13 .79%、10 .3 4%、10 .3 4%和 8.62 %。采用Westernblot法对UC患者血清进行检测 ,发现显示特异蛋白条带者占 4 8.2 8% ,其中显示分子量为 4 70 0 0条带者最多 ,占 2 2 .4 1%。结论　ANCA检测可作为UC的辅助诊断手段。目前 ,UC相关ANCA的靶抗原仍未明确 ,研究发现 4 70 0 0蛋白可能是UC相关ANCA的靶抗原之一。ANCA可能参与UC的致病机制。

The diagnostic significance of antineutrophil cytoplasmic antibodies in ulcerative colitis

Objective To inquire into the diagnostic significance of antineutrophil cytoplasmic antibodies (ANCA) in ulcerative colitis (UC). Methods Serum ANCA from 58 UC patients, 43 non UC patients and 58 healthy donors were detected with indirect immunoflorescence (IIF), enzyme linked immunosorbent assay(ELISA)and Western blot. Results The sensitivity and specificity of the presence of ANCA in the diagnosis of UC were 37.93% and 100% respectively. In the group of UC, patients with mild, moderate and severe clinical manifestations had positive ANCA rates of 17.65%, 41.67% and 52.94% respectively. The occurrence rates of mucosal vasculitis and grade III V mucosal inflammation were 78.95% and 78.95% respectively in ANCA positive group, but 37.04% and 44.44% in ANCA negative group. The levels of the binding of the five kinds of ANCA antigens i.e. myeloperoxidase (MPO), bactericidal/permeability increasing protein(BPI), lactoferrin (LF), cathepsinG(CG) and proteinase 3(PR 3) with the serum of UC patients were 13.99%, 13.79%, 10.34% 10.34% and 8 62% respectively. Specific protein strips were observed in 48.28% of the UC patients with Western blot technique, 47 000 polypeptide being the most common and making up 22.41% of them. Conclusion The detection of ANCA was an auxiliary method for the diagnosis of UC.At present, UC associated target antigens were not yet clarified, 47 000 polypeptide may be one of them. ANCA may participate in the pathogenesis of UC.