炎症性肠病相关血清标志物在克罗恩病诊断中的研究

Study on Serum Markers Associated with Inflammatory Bowel Disease in the Diagnosis of Crohn's Disease

目的评价血清标志物抗酿酒酵母抗体(ASCA)、核周型抗中性粒细胞胞质抗体(pANCA)、抗乙糖苷甘露糖抗体(AMCA)、抗乙糖苷壳糖抗体(ACCA)、鞭毛蛋白抗体(anti-CBir1)、假单胞菌荧光相关性序列(I2)、大肠杆菌外膜蛋白C复合物抗体(OMPC)对克罗恩病(CD)诊断的临床价值。方法收集2016年12月至2018年6月于四川大学华西医院消化内科住院和门诊,经临床评估、肠镜、病理和影像学明确的63例CD患者的血清样本;并对63例CD患者根据蒙特利尔分型标准进行亚型分组:确诊年龄(A1、A2、A3),病变部位(L1、L2、L3、L4),疾病行为(B1、B2、B3)。收集同期10例正常人作健康对照;采集患者和健康对照者血清标本及CD组临床资料,检测相关血清指标。结果CD组ASCA及ASCA-IgG检出率明显高于健康对照组,差异有统计学意义(P<0.05);CD组中ASCA-IgG阳性检出率高于ASCA-IgA。其余血清标志物在CD组与健康对照组间比较,差异无统计学意义(P>0.05)。CD各亚组间ASCA阳性检出率高于其他血清标志物,其余血清标志物在各亚组中的阳性检出率较低,仅发现AMCA在A3组中有较高的阳性检出率,差异有统计学意义(P<0.05);但I2、OMPC阳性的患者均为小肠受累合并狭窄,考虑该两种血清标志物可能与病变部位及疾病行为有相关性。结论ASCA、ASCA-IgG在CD中的阳性检出率较高,最具诊断价值。AMCA可能与疾病的发病年龄有相关性。在CD组ACCA、anti-CBirl、I2、OMPC组间比较,差异无统计学意义(P>0.05)。但I2、OMPC阳性的患者病变部位均在小肠,且合并狭窄,考虑这两种标志物可能与病变部位、疾病行为有相关性。

Objective To evaluate the clinical value of serum markers anti-Saccharomyces cerevisiae antibody(ASCA),perinuclear anti-neutrophil cytoplasmic antibodies(pANCA),anti-manno-bioside carbohydrate IgG antibodies(AMCA),anti-chitobioside carbo-hydrate IgA antibodie(ACCA),antibody to the outer membrane protein of Esch-erichia coli(anti-CBir1),anti-Pseudomonas fluorescens associated sequence(I2),and antibodies against outer mem-brane porin C(OMPC)in the diagnosis of Crohn's disease(CD).Methods Serum samples were collected from 63 CD patients treated and confirmed by clinical evaluation,colonoscopy,pathology and imaging in the inpatient department and outpatient department of gastroenterology,West China Hospital of Sichuan University from December 2016 to June 2018.The subtypes of 63 CD patients were grouped according to Montreal classification criteria age of onset(A1,A2,A3),lesion site(L1,L2,L3,L4),and clinical behavior(B1,B2,B3).Ten healthy controls were collected during the same period.Serum samples of both CD patients and healthy controls were collected to detect relevant serum blood indicators.Clinical data of CD group were also collected.Results The detection rate of ASCA and ASCA-IgG in CD group was significantly higher than that in healthy control group,and the difference was statistically significant(P<0.05).The positive detection rate of ASCA-IgG in CD group was higher than that of ASCA-IgA.Other serum markers showed no significant difference between CD group and healthy control group(P>0.05).The positive detection rate of ASCA was higher than that of other serum markers in CD subgroups,while the positive detection rate of other serum markers in each subgroup was low,only a high positive detection rate of AMCA was found in A3 group,with statistically significant difference(P<0.05).However,I2 or OMPC positive patients were associated with small intestinal involvement and stenosis,which may be correlated with lesion site and disease behavior.Conclusion The positive rate of ASCA and ASCA-IgG in CD group is high,which has the most diagnostic value.AMCA may be correlated with the age of onset of the disease.There is no significant difference between ACCA,anti-CBirl,I2 and OMPC among the subgroups in CD group(P>0.05).However,I2 or OMPC positive patients had lesions in the small intestine and were associated with stenosis,which indicates the two markers might be correlated with lesion sites and disease behaviors.