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

The significance of combined assays of anti Saccharomyces cerevisia antibody and perinuclear antineutrophil cytoplasmic antibody on differentiatial diagnosis of inflammatory bowel disease

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。

Objective To assess the value of combined assays of anti Saccharomyces cerevisia antibody (ASCA) and perinuclear antineutrophil cytoplasmic antibody (pANCA) in differential diagnosis of inflammatory bowel disease (IBD). Methods Nineteen patients with IBD, including 9 patients with Crohn's disease(CD) and 10 patients with ulcerative colitis(UC), and 18 healthy subjects were enrolled into study. Serum levels of pANCA and ASCA (IgG and IgA) were measured by indirect immunofluorescence technique and a standardized ELISA, respectively. Results The serum levels of ASCA IgG and ASCA IgA in CD patients (18.51± 6.38 and 11.74 ± 5.46 ) were significantly higher than those in UC patients ( 6.98 ± 5.24 and 3.88 ± 3.52 ) and healthy subjects( 5.90 ± 4.12 and 4.62 ± 3.21 )respectively (P< 0.05 ). The sensitivity of pANCA in diagnosis of UC was 80%, and no case was positive in both CD patients and healthy controls. Conclusion The present study indicated that ASCA and pANCA had diagnostic specificity in patients of CD and UC. It was conceivable that ASCA as a marker correlated with CD while pANCA as an immunological index related to UC. The combination of ASCA and pANCA test had the differential diagnostic value in IBD patients.