血清学标志物联合检测用于诊断克罗恩病的相关研究

Study on joint detection of serological markers in the diagnosis of Crohn＇s disease

目的 探讨抗酿酒酵母抗体（ASCA） IgA、ASCA IgG、抗乙糖苷昆布糖抗体（ALCA）、抗乙糖苷壳糖抗体（ACCA）、抗甘露二糖抗体（AMCA）、抗大肠埃希菌外膜C蛋白抗体（OmpC抗体）、I2抗体在诊断CD中的价值.方法 收集2012年10月10日至2013年1月24日期间确诊为CD的患者63例,选取同期30例确诊为UC的患者作为疾病对照组,选取同期25例在内镜和影像学检查中未发现异常者为健康对照组.抽取所有研究对象清晨空腹静脉血,离心后取血清,用单盲ELISA法进行ASCA IgG、ALCA、AMCA、ACCA、ASCA IgA、O mpC抗体、I2抗体检测.计算各抗体的诊断灵敏度、特异度、阳性预测值和阴性预测值,用ROC曲线评估其诊断价值.结果 在单抗体检测鉴别诊断CD和UC中,AMCA的准确度最高,ROC曲线下面积为0.739.在单抗体检测筛查CD中,I2抗体的诊断准确度最高,ROC曲线下面积为0.751.在多抗体联合检测中,以ASCA IgA或AMCA中任意一项阳性为标准鉴别诊断CD和UC,以及进行CD筛查,其准确度均最高,ROC曲线下面积分别为0.612和0.633.结论 在临床工作中,或可通过检测AMCA、I2抗体、ASCA IgA来进行CD筛查,以及鉴别诊断CD和UC.

Objective To explore the values of detecting anti-Saccharomyces cerevisiae antibody （ASCA） IgA,ASCA IgG,anti laminaribioside carbohydrate antibody （ALCA）,anti-chitobioside carbohydrate antibody （ACCA） and anti mannobioside carbohydrate antibody （AMCA） and antibody against outer membrane porin C of Escherichia coli （anti-OmpC） in the diagnosis of Crohn＇s disease （CD）.Methods From October 10th 2012 to January 24th 2013,63 patients diagnosed as CD were selected.At the same period 30 patients diagnosed as ulcerative colitis （UC） were set as disease control group and 25 individuals without abnormal findings under endoscope and imaging examination were set as healthy control group.Fasting blood of all the subjects were drawn in the morning and serum was isolated after centrifuge.The level of ASCA IgG,ALCA,AMCA,ACCA,ASCA IgA,anti OmpC and I2 was detected by indirect enzyme linked immunosorbent assay.The sensitivity,specificity,positive predictive value and negative predictive value of each antibody were calculated and its value in the diagnosis was evaluated by receiver operating characteristic （ROC） curve.Results In the differential diagnosis of CD and UC by single antibody test,the accuracy of AMCA was the highest and the area under ROC curve was 0.739.In the screening of CD with single antibody examination,the diagnosis accuracy of I2 antibody was the highest and the area under ROC curve was 0.751.In multi antibodies joint examination,the accuracy of either ASCA IgA or AMCA positive was the highest in the differential diagnosis of CD and UC,also in the screening of CD and the area under ROC curve was 0.612 and 0.633,respectively.Conclusion In clinical practice,CD screening and the differential diagnosis of CD and UC may be achieved through detecting AMCA,ASCA IgA and I2 antibody.