抗酿酒酵母抗体和抗中性粒细胞胞浆抗体在炎症性肠病诊断的意义

Diagnostic Value in Anti-saccharomyces Mannan Cerevisiae and Anti-neutrophil Cytoplasmic Antibodies in the Serum of Patients with Inflammatory Bowel Disease

目的:探讨血清抗酿酒酵母抗体(anti-saccharomces cerevisiae antibody,ASCA)和核周型抗中性粒细胞胞浆抗体(perinuclear anti-neutrophil cytoplasmic antibody,pANCA)表达在炎症性肠病(inflammatory bowel disease,IBD)诊断中的临床意义。方法:选择133例在我院就诊的消化系疾病患者,其中86例溃疡性结直肠炎(ulcerative colitis,UC),11例克罗恩病(crohn's disease,CD)以及36例结肠镜检查正常者,并分别纳入UC组、CD组和正常对照组,采用间接免疫荧光法(indirect immunofluorescence,IIF)检测血清pANCA、ASCA表达。结果:pANCA在UC、CD和正常对照组阳性率分别为27.91%、0%、0%,UC组显著高于其他两组(P<0.01)。ASCA在CD、UC和正常对照组的阳性率分别为36.36%、4.65%、0%,CD组显著高于其他两组(P<0.01)。pANCA+/ASCA-诊断UC的敏感性、特异性和阳性预测值分别是27.91%、100.00%、100.00%,ASCA+/pANCA-诊断CD的敏感性、特异性和阳性预测值分别是36.36%、100.00%、100.00%。UC组出现1例pANCA、ASCA双阳性者,占总数的0.75%。结论:尽管ASCA、pANCA诊断UC、CD的敏感性不高,但特异性较好,两种血清标志物对于UC和CD的诊断具有一定的临床参考价值。

Objective：To retruspectively analyse the diagnostic value of the expression of anti-saeeharomyces cerevisiae antibody （ASCA）and perinuclear anti-neutrophil cytoplasmic antibody （pANCA）in the serum of the patients with Inflammatory Bowel Disease （IBD）. Methods：Serum samples were obtained from 133 patients with IBD including 86 ulcerative colitis cases,11 crohn＇s disease cases and 36 normal controls. Diagnosis was made on endoscopy and histology. Detemination of ASCA and pANCA antibodies was made using indirect immunofluorescence（IIF）. Results：pANCA in C D.UC and control groups was 27.91% ,0% and 0%. It was much higher in UC group than in the other groups（P 〈 0.01 ） ASCA in CD .UC and control groups was 36, 36% ,4. 65% ,0% respectively and it was much higher in CD group than in the other groups（P 〈 0. 01 ）. The sensitivity, specificity and positive value of positive ASCA and negative pANCA in the diagnosis of UC were 27.91% , 100.00% and 100.00% respectively. The sensibility,specificity and positive value of positive ASCA and negative pANCA in diagnosis of CD was 36.36% , 100.00% and 100.00% respectively. A dooble-positive case of pANCA and ASCA was detected in UC group（0. 75% ）. Conclusion： Although pANCA and ASCA are low in sensibility,anti high in specificity,they are useful in the diagnosis of UC and CD.