儿童炎症性肠病生物学标志物检测及其临床意义

Detection of biomarkers and its clinical significance in the inflammatory bowel disease in Children

目的探讨生物学标志物在炎症性肠病(IBD)患儿诊断和鉴别诊断中的意义。方法选择IBD患儿22例,其中溃疡性结肠炎(UC)6例,克罗恩病(CD)16例;非IBD儿童24例。用间接荧光法测定血清核周型抗中性粒细胞胞浆抗体(pANCA),酶联免疫法测定抗酿酒酵母抗体(ASCA)IgG和IgA、抗乙糖苷甘露糖抗体(AMCA)IgG、抗乙糖苷壳糖抗体(ACCA)Ig A、抗细菌鞭毛蛋白抗体cBir1-IgG(Anti-c Bir1-IgG)和粪钙卫蛋白(FC)水平。结果 UC患儿血p ANCA抗体均阳性(100.0%),而CD患儿和非IBD儿童均阴性,三组间差异有统计学意义(P<0.01)。CD患儿血ASCA Ig A和抗cBir1-IgG阳性率均为62.5%,血ASCA Ig G阳性率为50.0%,血ACCA Ig A和AMCA IgG阳性率均为37.5%;而UC患儿和非IBD儿童上述抗体均阴性,差异有统计学意义(P均<0.01)。IBD患儿FC阳性率为100.0%,高于非IBD儿童的54.2%,差异有统计学意义(P<0.001)。结论血pANCA是诊断UC的特异性指标。血ACCA IgA、AMCA IgG、ASCA IgG和Ig A、抗cBir1-IgG对CD的诊断有一定特异性。FC增高可反映IBD病情的活动性,但不能作为IBD与非IBD鉴别诊断的依据。

Objective To investigate the biological markers and their clinical significance in diagnosis and differential diagnosis of infammatory bowel disease （IBD） in children. Methods The study had 22 cases of IBD including 6 cases of ulcerative colitis （UC） and 16 cases of Crohn’s Disease （CD）. Twenty-four children without IBD were selected as controls. The serum perinuclear anti-neutrophil cytoplasmic antibody （pNACA） was measured by indirect immune fuorescence method. The serum anti-saccharomyces cerevisiae antibody （ASCA） IgG and IgA, anti-B mannose glycoside antibody （AMCA） IgG, anti-B glycoside sugar shell antibody （ACCA） IgA, Anti-bacterial fagellin antibody （Anti-cBir1） IgG, and the fecal calprotectin （FC） were determined by Enzyme linked immunosorbent assay （ELISA）. Results The positive rate of serum pANCA was 100% in 6 cases of UC while it was negative in CD cases and control, and there was significant difference among three groups （P 〈 0.01）. In CD cases, both positive rate of serum ACCA IgA and that of Anti-cBir1-IgG were 62.5% and the positive rate of ACCA IgA was 37.5%. Meanwhile, all of them were negative in UC cases and control. There were signifcant differences among three groups （P〈0.01）. The positive rate of FC was 100% in children with IBD. It was signifcantly higher than the positive rate in control group, 54.2% （P 〈 0.01）. Conclusion The serum pANCA is a specifc index for the diagnosis of UC. The serum ACCA IgA, AMCA IgG, ASCA IgG and IgA, and Anti-cBir1 IgG were specifc to some extent in the diagnosis of CD. Increased FC can refect the activity of IBD, but cannot be used for the differential diagnosis of IBD and non IBD.