下消化道疾病患者血清抗中性粒细胞胞浆抗体和抗酿酒酵母抗体检测的临床意义

Diagnostic Role Anti-neutrophil Cytoplasmic Antibodies and Anti-Saccharomyces Mannan Cerevisiae in the Serum of Patients in 215 below Alimentary Tract Disease Patients

回顾性分析血清核周型抗中性粒细胞胞浆抗体(perinuclear anti-neutrophil cytoplasmic antibody,pANCA)和抗酿酒酵母抗体(anti-saccharomces cerevisiae antibody,ASCA)的表达在以炎症性肠病(inflammatory bowel disease,IBD)为主的下消化道疾病中的临床意义。用间接免疫荧光生物薄片法(indirect immunofluorescence technique,IIF)检测179例下消化道疾病患者,包括86例溃疡性结直肠炎(ulcerative colitis,UC),11例克罗恩病(Crohn,s disease,CD),27例肠炎,55例结直肠肿瘤和36例结肠镜检查正常对照者的血清pANCA、ASCA表达。结果表明,pANCA在UC、肠炎、结直肠肿瘤、CD和正常对照组的阳性率分别为:27.91%、3.70%、1.82%、0%、0%,UC组显著高于其他四组(p<0.01),而其他四组间比较均无差别(p>0.05)。ASCA在CD、UC、肠炎、结直肠肿瘤和正常对照组的阳性率分别为:36.36%、4.65%、0%、0%、0%,CD组显著高于其他四组(p<0.01),而其他四组间比较均无差别(p>0.05)。pANCA+/ASCA-诊断UC的敏感性、特异性和阳性预测值分别是27.91%、100%、100%,ASCA+/pANCA-诊断CD的敏感性、特异性和阳性预测值分别是36.36%、100%、100%。UC组出现1例pANCA、ASCA双阳性者,占总数的1.16%。结论尽管ASCA、pANCA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。

The diagnostic role using to determine perinuclear anti-neutrophil cytoplasmic antibody （pANCA） and anti-saccharomyces cerevisiae antibody （ASCA） in the serum of patients in the below alimentary tract disease patients was retrospectively analysed. Serum samples were obtained from 179 patients with below alimentary tract disease and 36 normal control . Diagnosis was established on endoscopy and histology. Detemination of ASCA and pANCA antibodies was performed using indirect immunofluorescence technique. The results showed that pANCA in UC,Enteritis,colorectal tumour , CD and control groups is 27.91% ,3.70%, 1.82% ,0% and 0% respectively, UC is higher than other groups （p 〈 0.01 ）. ASCA in CD, UC, Enteritis, colorectal tumour and control groups is 36.36%, 4.65%, 0%, 0%, 0% respectively , CD is higher than other groups （p 〈0.01 ）. The sensibility, specificity and positive value of combination of positive pANCA and negative ASCA to diagnosis UC are 27.91%, 100%, 100% respectively ; and those of combination of positive ASCA and negative pANCA to diagnosis CD are 36.36%, 100%, 100% respectively. A both positive of pANCA and ASCA is detected in UC group . Although pANCA and ASCA are lower sensibility, but higher specificity , they are useful to diagnosis UC and CD.