IgG及IgM对活动期溃疡性结肠炎患者病情的预测价值

The predictive value of IgG and IgM in patients with active ulcerative colitis

目的探讨免疫球蛋白G(IgG)及免疫球蛋白M(IgM)对活动期溃疡性结肠炎(ulcerative colitis,UC)患者病情严重程度及肠道病变范围的预测价值。方法纳入2012年1月至2019年4月青岛大学附属医院住院确诊的106例UC患者,依据改良Truelove和Witts Index疾病严重程度分型分为轻中度组及重度组;依据蒙特利尔分型分为左半结肠组(包括直肠型及左半结肠型)及广泛结肠组,回顾性分析各组患者的IgG、IgM、C-反应蛋白(CRP)及血细胞沉降率(ESR)水平,比较各组间指标的差异及与病情严重程度和病变范围的相关性,分析其预测价值。结果重度UC组的IgG(P<0.001)及IgM(P=0.036)水平明显低于轻中度UC组,CRP(P<0.001)及ESR(P=0.007)则明显高于轻中度UC组;广泛结肠组的IgG(P<0.001)水平明显低于左半结肠组,CRP(P=0.003)水平明显高于左半结肠组。Spearman相关性分析显示:在疾病严重程度方面,CRP及IgG水平与UC疾病严重程度分别呈高度及中度相关(r=0.540,P<0.001;r=-0.426,P<0.001),IgM及ESR均呈低度相关(r=-0.233,P=0.016;r=0.288,P=0.003)。在病变范围方面,IgG及CRP与UC病变范围呈中度相关(r=-0.384,P<0.001;r=0.314,P=0.002)。受试者工作特征曲线(ROC)显示:IgG(AUC=0.772)及IgM(AUC=0.636)用于评估UC患者病情严重程度的cut-off值分别为10.15 g/L及0.94 g/L;CRP(AUC=0.798)对于病情严重程度的预测价值优于IgG(AUC=0.772);而病变范围的预测中IgG(AUC=0.731)优于CRP(AUC=0.655)。结论外周血的IgG、IgM均对UC患者的疾病严重程度有一定的预测价值,IgG对病变范围有一定预测价值且优于CRP。

Objective To investigate the predictive value of IgG and IgM on the severity and extent of intestinal lesions in patients with active ulcerative colitis(UC).Methods A total of 106 UC in-patients in the Affiliated Hospital of Qingdao University from Jan.2012 to Apr.2019 were retrospectively enrolled.Patients were divided into the mildmoderate active group and the severe active group according to the modified Truelove-Witts severity index,and the left colon group(including rectal and left colon UC patients)and the extensive colon group according to Montreal classification.Levels of IgG,IgM,C-reactive protein(CRP),and erythrocyte sedimentation rate(ESR)were analyzed for each group.To compare the differences of indexes among groups and their correlation with the severity and the extent of intestinal lesions and to analyze the predictive values.Results The levels of IgG(P<0.001)and IgM(P=0.036)were significantly decreased and the levels of CRP(P<0.001)and ESR(P=0.007)were significantly increased in the severe active group compared with those in the mild-moderate active group.The level of IgG was significantly decreased(P<0.001)and the level of CRP was significantly increased(P=0.003)in the extensive colon group compared with that in the left colon group.Spearman correlation showed that the levels of CRP and IgG were highly and moderately correlated with the severity of UC(r=0.540,P<0.001;r=-0.426,P<0.001),the levels of IgM and ESR were lowly and moderately correlated with the severity of UC(r=-0.233,P=0.016;r=0.288,P=0.003),the levels of IgG and CRP were moderately correlated with the extent of UC(r=-0.384,P<0.001;r=0.314,P=0.002).The cut-off values of IgG(AUC=0.772)and IgM(AUC=0.636)for evaluating the severity of UC were 10.15 g/L and 0.94 g/L,respectively.ROC curve analysis showed the CRP(AUC=0.798)was better than IgG(AUC=0.772)in predicting the severity of UC,while IgG(AUC=0.731)was better than CRP(AUC=0.655)in predicting the extent of intestinal lesions.Conclusion Both IgG and IgM in peripheral blood have predictive value for the severity of UC,and IgG can predict the extent of intestinal lesions with a higher predictive value than CRP.