炎症性肠病患者血清中anti-CABP水平检测的临床意义

Clinical significance of serum anti-CABP detection in patients with inflammatory bowel disease

目的探讨抗克罗恩病抗体结合多肽(anti-CABP)检测在炎症性肠病(IBD)诊断中的临床意义。方法前瞻性分析2017年6月-2019年12月安徽医科大学第一附属医院确诊的190例IBD患者的临床资料,其中克罗恩病(CD)103例,溃疡性结肠炎(UC)87例,同时采用107例胃肠道息肉患者作为对照组。采用酶联免疫吸附法(ELISA)检测CD组、UC组、对照组患者的anti-CABP、抗酿酒酵母菌抗体(ASCA)和核周型抗中性粒细胞胞质抗体(pANCA)血清水平,统计分析3组间anti-CABP、ASCA和pANCA的血清表达水平和阳性率的差异。通过受试者工作特征曲线(ROC)分析anti-CABP的诊断价值。分析anti-CABP与IBD临床特征的关系。结果CD组anti-CABP IgA[14.46(7.77,34.71)U/ml比10.22(5.71,14.98)U/ml和6.60(5.04,8.38)U/ml,均P<0.01]、anti-CABP IgG[11.12(4.48,42.31)U/ml比5.26(3.28,10.02)U/ml和2.85(2.41,3.52)U/ml,均P<0.01]、ASCA IgG[5.59(2.68,11.36)U/ml比2.63(1.42,6.40)U/ml和2.19(1.20,4.03)U/ml,均P<0.01]水平明显高于UC组和对照组,UC患者pANCA水平显著高于CD组和对照组[8.55(4.06,19.98)U/ml比2.91(2.09,3.99)U/ml和1.65(1.24,2.23)U/ml,均P<0.01]。CD患者anti-CABP阳性率为45.63%,明显高于UC患者的4.60%(P<0.01)。anti-CABP诊断CD的AUC为0.840,明显优于ASCA的0.708。anti-CABP、ASCA、pANCA联合使用的AUC为0.892。anti-CABP IgA阳性率与CD患者临床特征均无显著相关关系(均P>0.05),anti-CABP IgG阳性率在CD患者不同发病部位的差异有统计学意义(P=0.016)。结论CD患者中anti-CABP阳性率明显高于UC患者,提示anti-CABP可作为血清学标志物辅助CD的诊断与鉴别诊断。

Objective To explore the clinical significance of anti-Crohn′s disease antibody binding polypeptide(anti-CABP)in the diagnosis of inflammatory bowel disease(IBD).Methods Clinical data of 190 IBD patients diagnosed in the First Affiliated Hospital of Anhui Medical University from June 2017 to December 2019 were analyzed prospectively,including 103 patients with Crohn’s disease(CD)and 87 patients with ulcerative colitis(UC).And 107 patients with gastrointestinal polyposis were set as control group.The serum level of anti-CABP,anti-Saccharomyces cerevisiae antibodies(ASCA)and perinuclear anti-neutrophil cytoplasmic antibodies(pANCA)were detected in CD,UC and control groups by using ELISA.The differences in the serum level and positive rates of anti-CABP,ASCA and pANCA among the three groups were analyzed statistically.The diagnostic value of anti-CABP was evaluated by using receiver operating characteristic(ROC)analysis.The correlation between anti-CABP and clinical characteristics of IBD was analyzed.Results The levels of anti-CABP IgA[14.46(7.77,34.71)U/ml vs.10.22(5.71,14.98)U/ml and 6.60(5.04,8.38)U/ml,both P<0.01],anti-CABP IgG[11.12(4.48,42.31)U/ml vs.5.26(3.28,10.02)U/ml and 2.85(2.41,3.52)U/ml,both P<0.01]and ASCA IgG[5.59(2.68,11.36)U/ml vs.2.63(1.42,6.40)U/ml and 2.19(1.20,4.03)U/ml,both P<0.01]of CD patients were significantly higher than those of UC patients and control group.The pANCA level in UC patients was significantly higher than that of CD and control groups[8.55(4.06,19.98)U/ml vs.2.91(2.09,3.99)U/ml and 1.65(1.24,2.23)U/ml,both P<0.01].The positive rate of anti-CABP was 45.63%in CD patients,which was obviously higher than 4.60%in UC patients(P<0.01).Anti-CABP could effectively distinguish CD from non-CD patients(AUC 0.840),and the diagnostic efficacy of anti-CABP was better than that of ASCA(AUC 0.708).The combined use of three antibodies(anti-CABP,ASCA and pANCA)significantly improved the diagnostic value and the AUC was 0.892.The positive rate of anti-CABP IgA was not related with the clinical characteristics of IBD(all P>0.05),while the positive rate of anti-CABP IgG was significantly different in the disease locations of CD patients(P=0.016).Conclusion The positive rate of anti-CABP in CD patients is significantly higher than that in UC patients,which suggests that the anti-CABP can be used as a serological marker to assist diagnosis and differential diagnosis of CD.