血清抗酿酒酵母菌抗体检测对克罗恩病的临床价值

Clinical significance of detecting anti-Saccharomyces cerevisiae antibody in Crohn＇s disease

目的：评价血清抗酿酒酵母菌抗体（ASCA）IgG 和 IgA 的检测对 CD 诊断的临床价值。方法收集51例 CD 患者为 CD 组，22名健康体检者为健康对照组，收集两组的血清标本，采用 ELISA定性检测 ASCA-IgG 和 ASCA-IgA。根据蒙特利尔分类标准将 CD 患者分别按发病年龄（A）、病变部位（L）、临床行为（B）分亚组。计算检测 CD 组和健康对照组的 ASCA-IgG 和 ASCA-IgA 的敏感度、特异度和阳性预测值。计数资料比较采用卡方检验。结果CD 组 ASCA-IgG 和 ASCA-IgA 的敏感度分别为45．1％、35．3％，健康对照组分别为0、9．1％，两组比较差异均有统计学意义（χ2＝14．49、5．31，P 均＜0．05）。CD 组 ASCA-IgG 的特异度和阳性预测值均为100．0％，ASCA-IgA 的分别为91．0％和90．0％。A1，A2，A3组中 ASCA-IgG 的敏感度分别为75．0％、36．4％、57．1％，ASCA-IgA 的敏感度分别为25．0％、30．3％、50．0％；L1，L2，L3组中 ASCA-IgG 的敏感度分别为38．5％、37．5％、57．1％，ASCA-IgA 的敏感度分别为30．8％、31．3％、42．9％；B1，B2，B3组中 ASCA-IgG 的敏感度分别为45．2％、50．0％、25．0％，ASCA-IgA 的敏感度分别为29．0％、50．0％、25．0％；CD 各亚型分组间 ASCA-IgG 和ASCA-IgA 的敏感度比较，差异均无统计学意义（P 均＞0．05）。有并发症和无并发症 CD 患者的ASCA-IgG 敏感度分别为56．3％和26．3％，差异有统计学意义（χ2＝4．31，P ＜0．05）。结论血清ASCA-IgG 不适合作为人群筛查指标，但对于 CD 的鉴别诊断有一定价值。检测 ASCA-IgG 的临床价值高于检测 ASCA-IgA。

Objective To evaluate the clinical significance of detecting serum anti-Saccharomyces cerevisiae antibody （ASCA）IgG and IgA in the diagnosis of Crohn′s disease（CD）.Methods A total of 51 patients with CD were enrolled as CD group and 22 healthy volunteers as healthy control group.The serum samples of both groups were collected.ASCA-IgG and ASCA-IgA were determined with enzyme linked immunosorbent assay （ELISA）.According to Montreal standard,patients with CD were divided into subgroup according to the age of onset （A）,lesion （L）,clinical behavior （B）.The sensitivity, specificity and positive predictive value of both groups were calculated.Chi-square test was performed for count data analysis.Results The sensitivities of ASCA-IgG and ASCA-IgA in CD group were 45 .1 % and 35 .3%,respectively,while in the healthy control group which were 0 and 9.1 %,respectively.There were significant differences between two groups （χ2 =14.49 and 5 .31 ,both P 〈0.05 ）.The specificities and positive predictive values of ASCA-IgG in CD group were both 100.0%,and those of ASCA-IgA were 91 .0% and 90.0%.The sensitivities of ASCA-IgG in A1 ,A2 and A3 groups were 75 .0%,36.4% and 57.1 %,respectively,and those of ASCA-IgA,were 25 .0%,30.3% and 50.0%,respectively.The sensitivities of ASCA-IgG in L1 ,L2 and L3 groups were 38.5 %,37.5 % and 57.1 %,respectively,and those of ASCA-IgA were 30.8%,31 .3% and 42.9%,respectively.The sensitivities of ASCA-IgG in B1 , B2 and B3 groups were 45 .2%,50.0% and 25 .0%,respectively,and those of ASCA-IgA were 29.0%, 50.0% and 25 .0%,respectively.There was no significant difference in the sensitivities of ASCA-IgG and IgA between the subtgroups of CD group （all P 〉0.05 ）.The sensitivities of ASCA-IgG in CD patients with complications and without complications were 56.3% and 26.3%,respectively,and there was significant difference （χ2 =4.31 ,P 〈0.05）.Conclusions Serum ASCA-IgG is not suitable for population screening,however it has certain value for the differential diagnosis of CD.The clinical value of detecting ASCA-IgG is higher than that of detecting ASCA-IgA.