Anti-Saccharomyces cerevisiae antibody titers are stable over time in Crohn's patients and are not inducible in murine models of colitis

AIM： To investigate ASCA production over time in CD and murine colitis in order to further our understanding of their etiology. MATERIALS AND METHODS： Sixty-six CD patients were compared to ulcerative colitis （UC） and irritable bowel syndrome patients with respect to ASCA production as measured by ELISA. ASCA IgG or IgA positivity as well as change in titers over a period of up to 3 years （△tgG/A） was correlated with clinical parameters such as CD activity index （CDM） and C-reactive protein levels （CRP）. Moreover, two murine models of colitis （DSS and IL-10 knock out） were compared to control animals with respect to ASCA titers after oral yeast exposure. RESULTS： ASCA IgG and IgA titers are stable over time in CD and non-CD patients. Fistular disease was associated with a higher rate of ASCA IgA positivity （P = 0.014）. Ileal disease was found to have a significant influence on the △tgG of ASCA （P = 0.032）. There was no correlation found between ASCA positivity or △tgG/A and clinical parameters of CD： CDAI and CRP. In mice, neither healthy animals nor animals with DSS-induced or spontaneous colitis exhibited a marked increase in ASCA titers after high-dose yeast exposure. On the other hand, mice immunized intraperitoneally with mannan plus adjuvant showed a marked and significant increase in ASCA titers compared to adjuvant-only immunized controls （P = 0.014）. CONCLUSION： The propensity to produce ASCA in a subgroup of CD patients is largely genetically predetermined as evidenced by their stability and lack of correlation with clinical disease activity parameters. Furthermore, in animal models of colitis, mere oral exposure of mice to yeast does not lead to the induction of marked ASCA titers irrespective of concomitant colonic inflammation. Hence, environment may play only a minor role in inducing ASCA.

Differentiation of Behcet's disease from inflammatory bowel diseases:Anti-saccharomyces cerevisiae antibody and anti-neutrophilic cytoplasmic antibody

The differential diagnosis of Behcet's disease(BD) from inflammatory bowel disease(IBD) is sometimes difficult and challenging.Hereby,we suggested the utility of anti-saccharomyces cerevisiae antibody(ASCA) and anti-neutrophilic cytoplasmic antibody(p-ANCA) in the differential diagnosis of BD from IBD.

Update on Anti-Saccharomyces cerevisiae antibodies, anti-nuclear associated anti-neutrophil antibodies and antibodies to exocrine pancreas detected by indirect immunofluorescence as biomarkers in chronic inflammatory bowel diseases: Results of a multicent

AIM： Anti-Saccharomyces anti-nuclear associated cerevisiae antibodies （ASCA）, anti-neutrophil antibodies （NANA） and antibodies to exocrine pancreas （PAB）, are serological tools for discriminating Crohn＇s disease （CrD） and ulcerative colitis （UC）. Like CrD, coeliac disease （COD） is an inflammatory bowel disease （IBD） associated with （auto） antibodies. Performing a multicenter study we primarily aimed to determine the performance of ASCA, NANA and PAB tests for IBD diagnosis in children and adults, and secondarily to evaluate the prevalence of these markers in CoD. METHODS： Sera of 109 patients with CrD, 78 with UC, 45 with CoD and 50 healthy blood donors were retrospectively included. ASCA, NANA and PAB were detected by indirect immunofluorescence （IIF）. RESULTS： ASCA＋/NANA- profile displayed a positive predictive value of 94.2% for CrD. Detection of ASCA was correlated with a more severe clinical profile of CrD and treatment of the disease did not influence their serum levels. ASCA positivity was found in 37.9% of active CoD.PAB were found in 36.7% CrD and 13.3% CoD patients and were not correlated with clinical features of CrD, except with an early onset of the disease. Fifteen CrD patients were ASCA negative and PAB positive. CONCLUSION： ASCA and PAB detected by IIF are specific markers for CrD although their presence does not rule out a possible active CoD. The combination of ASCA, NANA and PAB tests improves the sensitivity of immunological markers for CrD. Repeating ASCA, NANA, and PAB testing during the course of CrD has no clinical value.

Partial overlap of anti-mycobacterial,and anti-Saccharomyces cerevisiae mannan antibodies in Crohn's disease

AIM： To test whether humoral immune reaction against mycobacteria may play a role in anti- Saccharomyces cerevisiae antibodies （ASCA） generation in Crohn＇s disease （CD） and/or whether it correlates with clinical subtypes. METHODS： The dominant ASCA epitope was detected by Galanthus nivalis lectin （GNL）-binding assay. ASCA and IgG against mycobacterial lysates （M avium, M smegmatis, M chelonae, M bovis BCG M avium ssp. paratuberculosis （MAP）] or purified lipoarabinomannans （LAM） were detected by ELISA. ASCA and anti-mycobacterial antibodies were affinity purified to assess cross-reactivities. Anti-mycobacterial IgG were induced by BCG-infection of mice. RESULTS： GNL bound to different extents to mycobacterial lysates, abundantly to purified mannosecapped （Man） LAM from M tuberculosis, but not to uncapped LAM from M srnegrnatis. Fifteen to 45% of CD patients but only 0%-6% of controls were seropositive against different mycobacterial antigens. Anti-mycobacterial IgG correlated with ASCA （r = 0.37-0.64; P = 0.003-P 〈 0.001）. ASCA-positivity and deficiency for mannan-binding lectin synergistically associated with anti-mycobacterial IgG. In some patients, anti-mycobacterial antibodies represent crossreactive ASCA. Vice-versa, the predominant fraction of ASCA did not cross-react with mycobacteria. Finally, fistulizing disease associated with antibodies against M avium, M smegmatis and MAP （P = 0.024, 0.004 and 0.045, respectively）. CONCLUSION： Similar to ASCA, seroreactivity against mycobacteria may define CD patients with complicated disease and a predisposition for immune responses against ubiquitous antigens. While in some patients anti-mycobacterial antibodies strongly cross-react with yeast mannan; these cross-reactive antibodies only represent a minor fraction of total ASCA. Thus, mycobacterial infection unlikely plays a role in ASCA induction.

Seroreactivity against Saccharomyces cerevisiae in patients with Crohn's disease and celiac disease

AIM:To explore whether there was anti-Saccharomyces cerevisiae antibodies (ASCA) positivity in our patients with biopsy-confirmed celiac disease. METHODS:A cohort of patients with inflammatory bowel diseases (42 patients with Crohn's disease and 10 patients with ulcerative colitis) and gluten sensitive enteropathy (16 patients) from Debrecen,Hungary were enrolled in the study. The diagnosis was made using the formally accepted criteria. Perinuclear antineutrophil cytoplasmic antibodies (pANCA) and anti-Saccharomyces cerevisiae antibodies (ASCA), antiendomysium antibodies (EMA),antigliadin antibodies (AGA) and anti human tissue transglutaminase antibodies (tTGA) were investigated. RESULTS:The results showed that ASCA positivity occurred not only in Crohn's disease but also in Celiac disease and in these cases both the IgG and IgA type antibodies were proved. CONCLUSION:It is conceivable that ASCA positivity correlates with the (auto-) immune inflammation of small intestines and it is a specific marker of Crohn's disease.

Anti-pancreatic antibody in Turkish patients with inflammatory bowel disease and first-degree relatives

AIM: To identify the role of anti-pancreatic antibody (PAB) in the diagnosis of inflammatory bowel diseases (IBD) among Turkish patients, and its frequency in firstdegree relatives.METHODS: PAB and anti-Saccharomyces cerevisiae (ASCA) were examined in serum samples of 214 subjects including patients with Crohn's disease (CD, n = 64), ulcerative colitis (UC, n = 63), first-degree relatives of patients with CD (n = 25), first-degree relatives of patients with UC (n = 28),and a control group with gastrointestinal symptoms other than (IBD) (n = 34) by indirect immunofluorescence Positivity of PAB and ASCA was compared in terms of Vienna classification, disease activity and medications used.RESULTS: In terms of PAB positivity, no difference was found between patients with CD (14.1%) and UC (7.9%) however, significant difference was observed between patients with CD and subjects in the control group (P < 0.05). No difference was found between patients with CD and their relatives in terms of ASCA positivity, whereas a significant difference was found between other groups (P < 0.001). Compared to ASCA, the sensitivity of the PAB was 19% (7/37), its specificity was 93% (25/27), positive predictive value was 77% (7/9) and negative predictive value was 45% (25/55). ASCA was found with significantly higher prevalence in patients with CD activity index > 150 (P < 0.05).CONCLUSION: PAB is valuable in the diagnosis of IBD rather than CD, but cannot be used alone for diagnostic purposes. PAB is not superior to ASCA in CD diagnosis and in detecting CD among relatives of patients with CD.

Anti-microbial antibodies in celiac disease:Trick or treat?

AIM： To determine the prevalence of a new set ot anti-glycan and anti-outer membrane protein （anti- OMP） antibodies in a Hungarian cohort of adult Celiac disease （CD） patients. METHODS： 190 consecutive CD patients [M/F： 71/119, age：39.9 （SD：14.1） years], 100 healthy, and 48 gastrointestinal controls were tested for glycan anti-Saccharomyces cerevisiae （gASCA）, anti-laminaribioside （ALCA）, anti-chitobioside, anti-mannobioside, anti-OMP antibodies and major NOD2/CARD15 mutations. Thirty out of 82 CD patients enrolled at the time of diagnosis were re-evaluated for the same antibodies after longstanding gluten-free diet （GFD）. RESULTS： 65.9% of the CD patients were positive for at least one of the tested antibodies at the time of the diagnosis. Except anti-OMP and ALCA, antimicrobial antibodies were exclusively seen in untreated CD; however, the overall sensitivity was low. Any glycan positivity （LR＋： 3.13; 95% CI： 2.08-4.73） was associated with an increased likelihood ratio for diagnosing CD. Significant correlation was found between the levels of anti-glycan and anti-endomysial or anti-transglutaminase antibodies. Anti-glycan positivity was lost after longstanding GFD. Anti-glycan antibody titers were associated with symptoms at presentation, but not the presence of NOD2/CARD15 mutations. Patients with severe malabsorption more frequently had multiple antibodies at diagnosis （P = 0.019）. CONCLUSION： The presence of anti-glycan antibodies in CD seems to be secondary to the impaired small bowel mucosa which can lead to increased antigen presentation. Furthermore, anti-glycan positivity may be considered an additional marker of CD and dietary adherence.

Diagnosis of Crohn's disease in India where tuberculosis is widely prevalent

AIM:To define the parameters that positively predict diagnosis of Crohn's disease (CD) and differentiate it from gastrointestinal tuberculosis (GITB). METHODS:This prospective study over 3 years was carried out in the consecutive Indian patients with definite diagnosis of CD and equal numbers of patients with definite diagnosis of GITB. Demographic, clinical, laboratory, morphological and histological features were noted in all the patients. Serological tests such as p-ANCA, c-ANCA, IgA ASCA and IgG ASCA, were performed. Endoscopic biopsy and/or surgical tissue specimens were subjected to smear and culture for acid-fast bacilli (AFB) and tissue polymerase chain reaction for tuberculosis (TB PCR). Diagnosis of CD and GITB was based on the standard criteria. Data were analyzed using univariate Chi-square test and multiple logistic regression (MLR). RESULTS:The study is comprised of 26 patients with CD (age 36.6 ± 8.6 year, male:female, 16:10) and 26 patients with GITB (age 37.2 ± 9.6 year, male:female, 15:11). The following clinical variables between the two groups (CD vs TB) were significant in univariate analysis:duration of symptoms (58.1 ± 9.8 vs 7.2 ± 3.4 mo), diarrhoea (69.2% vs 34.6%), bleeding per rectum (30.7% vs 3.8%), fever (23.1% vs 69.2%), ascites (7.7% vs 34.6%) and extra-intestinal manifestations of inflammatory bowel disease (61.5% vs 23.1%). Of these, all except ascites and extra-colonic manifestations were found statistically significant by MLR. Accuracy of predicting CD was 84.62% based on the fever, bleeding P/R, diarrhoea and duration of symptoms while it was 63.4% when histology was reported as inflammatory bowel disease and 42.3% when there was recurrence of disease after surgery. Accuracy of predicting GITB was 73.1% when there was co-existing pulmonary lesions and/or abdominal lymphadenopathy;75% when tuberculosis was reported in histology;63.4% when granuloma was found in histology;82.6% when TB PCR was positive;and 61.5% when smear and/ or culture was positive for AFB. Serological test was not useful in differentiation of CD from GITB. Positivity rates for CD and GITB were:p-ANCA-3.8% and 3.8%, c-ANCA-3.8% and 0%, IgA ASCA-38.4% and 23.1%, and IgG ASCA-38.4% and 42.3%, respectively. CONCLUSION:Simple clinical parameters like fever, bleeding P/R, diarrhoea and duration of symptoms have the highest accuracy in differentiating CD from GITB.

Serologic and laboratory markers in prediction of the disease course in inflammatory bowel disease

The search for biologic markers that can assess the natural history and perhaps predict the course of individual's disease including response to treatments over time has become an important focus of inflammatory bowel disease research.The knowledge of an individual's prognosis can help physicians and patients make important management decisions and aid communication on risk and benefits of disease and treatment.

炎症性肠病患者中四种自身抗体联合检测的临床意义

为探讨联合测定血清抗中性粒细胞胞浆抗体(ANCA)、抗酿酒酵母菌抗体(ASCA)、抗小肠杯状细胞抗体(IGA)、抗胰腺腺泡抗体(PAB)对溃疡性结肠炎(UC组)和克罗恩病(CD组)的诊断和鉴别诊断价值。用间接免疫荧光法测定20例UC组和20例CD组以及10例肠道疾病组患者和5名健康对照组血清ANCA、ASCA、IGA、PAB水平。在四个组中ANCA的阳性率分别为70%、25%、10%和0%,UC组显著高于后三组(P<0.05);而ASCA的阳性率分别为15%、60%、10%和0%,CD组显著高于其他三组(P<0.05)。IGA阳性率分别为30%、65%、10%和0%,CD组亦显著高于二个对照组(P<0.05),但与UC组比较,无显著性差异(P>0.05)。ANCA+/ASCA诊-断UC的敏感性、特异性和阳性、阴性预测值分别是55%、90%、84.6%和66.7%,而ASCA+/ANCA-的诊断CD分别是35%、95%、87.5%和59.4%。IGA+/ANCA的-诊断CD分别是45%、95%、90%和63.3%;AN-CA、ASCA和IGA阳性有利于炎症性肠病(IBD)的诊断却不能敏感地筛选;ANCA、ASCA和IGA联合检测可作为UC和CD鉴别诊断,是IBD非创伤性鉴别诊断方法之一。

炎症性肠病血清学抗体的临床意义

背景:对于炎症性肠病(IBD),迄今尚无疾病诊断和监测的金标准。鉴于免疫系统在IBD发病中的重要作用,检测血清免疫特异性抗体水平对于IBD的诊断和鉴别诊断可能有一定价值。目的:探讨血清抗酿酒酵母抗体(ASCA)和核周型抗中性粒细胞胞质抗体(pANCA)在IBD中的临床意义。方法:连续纳入2015年2月—2016年5月苏州大学附属第一医院收治的IBD患者91例,其中克罗恩病(CD)52例,溃疡性结肠炎(UC)39例,36例排除IBD的胃肠道疾病患者作为对照组。分别采用ELISA法和间接免疫荧光法检测血清ASCA-IgG、IgA和pANCA。以临床诊断为金标准,采用四格表对ASCA、pANCA进行诊断试验评价;采用ROC曲线、Pearsonχ2检验、Fisher精确检验分析两种血清学抗体与IBD、CD、UC以及病变部位的关系。结果:血清ASCA-IgG和IgA均与CD相关(AUC=0.626和0.614),而UC仅与ASCA-IgA相关(AUC=0.486)。血清pANCA与IBD(r=0.342)、CD(r=-0.262)、UC(r=0.614)均相关,对IBD和UC的诊断敏感性和特异性优于CD(P<0.05)。CD患者的ASCA-IgG与病变累及回肠末端相关(P<0.05),pANCA与病变累及结肠相关(P<0.05);UC患者的ASCA-IgG、IgA均与病变累及回肠末端相关(P<0.05)。结论:血清ASCA、pANCA有助于在IBD诊断确立的基础上区分CD与UC,并可能对病变部位具有提示作用。ASCA可能与病变累及回肠末端相关,而pANCA则可能与病变累及结肠相关。

核周型抗中性粒细胞胞质抗体和抗酿酒酵母抗体在炎症性肠病中的临床意义

背景:核周型抗中性粒细胞胞质抗体(pANCA)和抗酿酒酵母抗体(ASCA)是一组与炎症性肠病(IBD)密切相关的免疫球蛋白,但对溃疡性结肠炎(UC)、克罗恩病(CD)的诊断和鉴别诊断的价值仍有待进一步验证。目的:探讨pANCA和ASCA在UC与CD诊断和鉴别诊断中的意义。方法:以酶联免疫吸附测定(ELISA)检测64例UC、62例CD和56例健康对照者的血清pANCA、ASCA水平和阳性率,分析pANCA、ASCA及其组合的诊断敏感性、特异性、阳性预测值(PPV)和阴性预测值(NPV)。结果:UC组血清pANCA水平[(584.22±347.70)pg/ml对(304.99±211.10)pg/ml和(390.92±82.82)pg/ml,P<0.01]和阳性率(50.0%对14.5%和14.3%,P<0.01)显著高于CD组和健康对照组,三组间血清ASCA水平和阳性率无明显差异。pANCA^+和pANCA^+/ASCA-诊断UC的敏感性、特异性、PPV和NPV分别为50.0%、85.7%、80.0%、60.0%和42.2%、89.3%、81.8%、57.5%,ASCA^+和ASCA^+/pANCA^-诊断CD的敏感性、特异性、PPV和NPV分别为8.1%、87.5%、41.7%、46.2%和3.2%、91.1%、28.6%、45.9%。结论:pANCA阳性有利于UC的诊断。pANCA/ASCA联合检测有助于鉴别UC,但对CD诊断价值不高。

炎症性肠病血清相关抗体检测的临床价值

[目的]研究核周型抗中性粒细胞胞浆抗体(pANCA)、抗小肠杯状细胞抗体(GAB)、抗胰外分泌腺抗体(PAB)和抗酿酒酵母菌抗体(ASCA)在炎症性肠病(IBD)诊断与鉴别诊断中的临床价值。[方法]采用间接免疫荧光薄片法检测54例溃疡性结肠炎组(UC)、17例克罗恩病组(CD)、26例肠道疾病对照组及5例正常对照组血清中4种抗体的表达。[结果]pANCA在UC组阳性率为44.4%,明显高于其他各组(P<0.01)。GAB在UC组阳性率为35.2%,与疾病对照组及正常对照组比较差异有显著性意义(P<0.05),在CD组阳性率为23.5%,与对照组比较差异无显著性意义(P>0.05);两者的表达均与UC严重程度无关。ASCA在CD组阳性率为17.6%,略高于UC组(1.9%),但两组比较差异无显著性意义(P>0.05),与疾病对照组及正常对照组比较差异亦无显著性意义(P>0.05)。PAB在实验中无一例阳性表达。联合检测4种抗体诊断IBD的敏感性、特异性和阳性阴性预测值分别为54.9%、90.3%、92.9%和46.7%。pANCA+/ASCA-诊断UC的敏感性和特异性为42.6%和94.1%,pANCA-/ASCA+诊断CD的敏感性和特异性为17.6%和100%。[结论]炎症性肠病相关抗体检测的特异性较高,但敏感性低,联合检测能明显提高敏感性。pANCA和GAB对于诊断和鉴别诊断UC较有价值,而ASCA和PAB对于诊断IBD意义不大。pANCA联合ASCA、GAB检测,对于UC和CD的鉴别诊断有一定价值。

抗中性粒细胞胞质抗体和抗酿酒酵母抗体表达在炎症性肠病诊断中的意义

目的回顾性分析血清核周型抗中性粒细胞胞质抗体(pANCA)和抗酿酒酵母抗体(ASCA)的表达在炎症性肠病(IBD)诊断中的意义。方法间接免疫荧光生物薄片(IIFT)法检测97例IBD患者血清pANCA、ASCA表达,其中86例溃疡性结直肠炎(UC)列入UC组,11例克罗恩病(CD)列入CD组,另设36例结肠镜检查正常者为对照组。结果pANCA在UC、CD和对照组的阳性率分别为27.9%、0%和0%,UC组显著高于其他两组(P<0.01);ASCA在CD、UC和对照组的阳性率分别为36.4%、4.7%和0%,CD组显著高于其他两组(P<0.01)。86例UC患者中,重度UC 23例(26.7%),其中pANCA+6例(26.1%),ASCA+2例(8.7%),pANCA+/ASCA+1例(4.4%);轻、中度UC 63例(73.3%),其中pANCA+18例(28.6%)。重度与轻、中度UC患者pAN-CA表达情况无显著差异(P>0.05)。11例CD患者中,重度CD 4例(36.4%),其中ASCA+3例(75.0%);轻、中度CD 7例(63.6%),其中ASCA+1例(14.3%)。重度CD患者ASCA阳性率明显高于轻、中度CD患者(P<0.05)。结论ASCA、pANCA两种血清标志物对诊断UC和CD具有一定临床参考价值。

抗中性粒细胞和酿酒酵母细胞抗体测定在炎症性肠病中的应用

目的探讨抗中性粒细胞抗体(ANCA)、抗酿酒酵母抗体(ASCA)在炎症性肠病(IBD)诊断、鉴别诊断中的意义,分析其与病变程度及范围的关系。方法用酶联免疫吸附测定(ELISA)检测36例UC、20例CD、25例疾病对照者及30例健康对照者的血清ASCA-IgA、ASCA-IgG和ANCA水平。结果36例UC组血清ANCA水平和阳性率显著高于CD组、疾病对照组、健康对照组[ANCA水平:(24.43±34.24)×10-3U/L比(4.53±2.46)、(2.84±1.17)、(2.82±0.71)×10-3U/(L均P<0.01);阳性率:52.8%(19/36)比5.0%(1/20)、8.0%(2/25)和0%(0/30),χ2值分别为12.783、13.104、22.234,均P<0.01]。20例CD患者ASCA水平和阳性率均高于UC组、疾病对照组、健康对照组(均P<0.01)。ANCA和ANCA+/ASCA-诊断UC的敏感性、特异性分别为52.8%、96.0%和50.0%、97.3%,ASCA+和ASCA+/ANCA-诊断CD敏感性、特异性分别为55.0%、94.6%和50.0%、95.6%。ANCA的阳性率高低与UC的严重程度、病变范围无关,ASCA的阳性率高低与CD严重程度无关。结论 ANCA阳性有助于UC的诊断,ASCA阳性有助于CD的诊断,ASCA/ANCA联合检测有助于鉴别UC和CD。ANCA与UC患者病变程度及范围均无相关性,ASCA与CD患者临床严重程亦无相关性。

炎症性肠病相关抗体检测的临床价值研究

目的研究炎症性肠病(IBD)相关抗体IgA和IgG型抗小肠杯状细胞抗体(GAb)、抗中性粒细胞胞浆抗体(pANCA)、抗胰腺腺泡抗体(PAb)和抗酿酒酵母抗体(ASCA)检测的临床价值。方法收集2016年11月-2019年1月黑龙江省医院溃疡性结肠炎(UC)144例、克罗恩病(CD)38例、IBD类型待定32例和结肠息肉36例,间接免疫荧光法检测抗体在患者血清中的表达。结果GAb-IgG在IBDU组阳性率75.0%,IgA/IgG型pANCA在UC组阳性率为30.6%和50.0%,ASCA-IgA在CD组和IBDU组阳性率为42.1%和43.8%,差异具有统计学意义;GAb-IgA、IgA/IgG型PAb、ASCA-IgG阳性率低,差异无统计学意义。GAb-IgA、IgA/IgG型pANCA诊断UC的特异性为100.0%,GAb-IgG为66.7%;PAb-IgA、IgA/IgG型ASCA诊断CD的特异性为100.0%,PAb-IgG为94.4%。结论IgA/IgG型pANCA在UC组阳性率高,ASCA-IgA在CD组阳性率高;GAb-IgG和ASCA-IgA在IBDU组阳性率高。GAb-IgA、IgA/IgG型pANCA诊断UC的特异性高,GAb-IgG特异性偏低;PAb和ASCA诊断CD的特异性高。除GAb-IgG外,IBD相关抗体特异性都很高,阳性能够提示IBD可能。

探讨国内抗酿酒酵母抗体（ASCA）鉴别诊断克罗恩病的截断点（cutoff值）的相关研究

目的检测抗酿酒酵母抗体IgG、IgA在克罗恩病患者中的表达水平,探讨其鉴别诊断克罗恩病的cutoff值。方法纳入2018年10月~2019年4月期间诊断为克罗恩病的患者109例,溃疡性结肠炎30例,内镜检查无异常者25例。间接酶联免疫检测法测定患者血清中抗酿酒酵母抗体IgG、IgA表达水平,计算其cutoff值、灵敏度、特异度等指标。结果抗酿酒酵母抗体的阳性率为47.71%,抗酿酒酵母抗体IgG的cutoff值为10.5,灵敏度为71.56%,特异度为61.82%;抗酿酒酵母抗体IgA的cutoff值为0.415,灵敏度为66.06%,特异度为78.18%;两者任一阳性的灵敏度为85.32%,两者均阳性的特异度为80.00%。结论抗酿酒酵母抗体IgG、IgA在中国人群克罗恩病患者中的表达水平不高,需制定相应的cutoff值,两者联合检测可提高克罗恩病患者检出率。

Luminex液态芯片技术在克罗恩病诊断与病情监测中的应用

目的探讨Luminex液态芯片技术检测血清中细胞因子的表达在克罗恩病患者中的临床意义。方法选取不同严重程度克罗恩病(CD)患者76例作为研究对象,选取同期健康人群50例作为对照组。按照MILLIPLEX MAP Kit试剂盒的要求,利用Luminex技术检测血清中细胞因子白细胞介素2(IL-2)、γ干扰素(IFN-γ)、肿瘤坏死因子(TNF-α)、白细胞介素4(IL-4)、白细胞介素6(IL-6)、白细胞介素10(IL-10)以及白细胞介素17A(IL-17A)的表达水平,采用酶联免疫吸附试验(ELISA)测定血清中抗酿酒酵母抗体(ASCA),分析CD组与健康对照组之间的差异。结果细胞因子表达水平除IL-17A外,CD组IL-2、IFN-γ、TNF-α、IL-4、IL-6、IL-10水平均高于健康对照组,差异有统计学意义(P<0.05);活动期CD患者血清IFN-γ、TNF-α、IL-6水平明显高于缓解期和健康对照组,差异有统计学意义(P<0.05);中、重度活动期CD患者血清TNF-α、IL-6水平高于轻度活动期CD患者,差异有统计学意义(P<0.05);血清ASCA水平在CD组与健康对照组比较,差异有统计学意义(P<0.05),ASCA阳性患者TNF-α、IL-6水平显著高于ASCA阴性患者,差异有统计学意义(P<0.05)。结论 TNF-α、IL-6在CD患者的炎症发生和病情发展中起着重要作用,测定血清TNF-α、IL-6的水平可反映克罗恩病的病情程度。细胞因子水平动态变化与CD病情进展相关,对CD疾病检测和病情监测具有重要意义。

三种不同品牌ELISA试剂盒检测ASCA的结果比较及性能评估

目的:比较3种品牌酶联免疫吸附试验(enzyme-linked immunosorbent assay, ELISA)试剂盒检测血清抗酿酒酵母菌抗体(anti-saccharomyces cerevisiae antibodies, ASCA)的结果,分析一致性情况,并评估各试剂盒的主要检测性能,为临床使用提供参考。方法:收集本院确诊炎症性肠病(inflammatory bowel disease,IBD)患者140例,其中克罗恩病(Crohn’s disease,CD)87例和溃疡性结肠炎(ulcerativecolitis, UC)53例,疾病对照组(disease contorl,DC)40例。用3个品牌的ELISA试剂盒(试剂盒A为国产品牌、B和C为进口品牌)分别检测ASCA-IgA和ASCA-IgG,对结果进行比较分析。结果:CD组中3个品牌试剂盒ASCA-IgA和(或)ASCA-IgG的检出率均高于UC组及DC组(P<0.05),而UC组与DC组间结果差异无统计学意义(P>0.05)。在UC组和DC组间,3种试剂的阳性检出率间差异无统计学意义(P>0.05);在CD组中,试剂盒A与B的阳性检出率间差异无统计学意义(P>0.05),而试剂盒C的结果低于试剂盒A、B,差异有统计学意义(P<0.05)。3种试剂检测结果的一致性分析显示,ASCA-IgA中,试剂盒A与B呈现中等一致性(Kappa:0.423),试剂盒A与C、试剂盒B与C的一致性较差(Kappa分别为0.111和0.074);ASCA-IgG中,试剂盒A与B、试剂盒B与C及试剂盒A与C均呈现中等一致性(Kappa分别为0.414、0.447和0.584)。评估3种ELISA试剂盒分别检测ASCA-IgA、ASCA-IgG及联合检测ASCA-IgA和ASCA-IgG诊断IBD的效能,试剂盒A灵敏度依次为37.90%、27.86%、43.57%,试剂盒B为20.71%、45.00%、51.43%,试剂盒C为9.29%、22.14%、25.71%;试剂盒A特异度依次为87.50%、85.00%、77.50%,试剂盒B为92.50%、90.00%、87.50%,试剂盒C为97.50%、90.00%、87.50%;试剂盒A约登指数分别为0.25、0.12、0.21,试剂盒B为0.13、0.35、0.38,试剂盒C为0.07、0.12、0.13;经受试者工作特征(receiver operating characteristic,ROC)曲线得出曲线下面积,试剂盒A分别为0.72、0.54、0.59,试剂盒B为0.54、0.72、0.69,试剂盒C为0.64、0.52、0.57。结论:3种试剂盒在CD组均具有较高的ASCA检出率,说明ELISA检测ASCA对于CD的诊断和鉴别诊断具有一定应用价值。不同试剂间的检测结果一致性尚不理想,3种试剂ASCA-IgG检测结果一致性总体优于ASCA-IgA结果。3种试剂灵敏度均较低,不适合作为人群的IBD筛查指标,同时检测IgG和IgA抗体可提高检测灵敏度。检测性能试剂B>A>C,进口试剂不一定优于国产试剂,可根据实际情况合理选择试剂。

原发性胆汁性肝硬化患者血清抗酿酒酵母抗体不同亚型的临床意义初探

目的 探讨原发性胆汁性肝硬化（PBC）患者血清中不同亚型的抗酿酒酵母抗体（ASCA）的临床意义.方法 采用酶联免疫吸附试验（ELISA）检测130例PBC患者、81例肝病（LDC组）患者、110例炎症性肠病（IBD组）及35例健康对照者血清ASCA的 IgA和IgG亚型.结果 PBC患者血清中ASCA-IgA亚型阳性率为22.3%,ASCA-IgG亚型阳性率10.0%;ASCA-IgA或ASCA-IgG亚型阳性率为26.9%;ASCA-IgA和ASCA-IgG亚型同时阳性率5.4%,PBC组患者ASCA-IgA或ASCA-IgG阳性率、ASCA-IgA阳性率与LDC、IBD组比较差异均无统计学意义（均P ＞0.05）,但与健康对照组比较差异有统计学意义（P＜0.05）;PBC组患者ASCA-IgA和ASCA-IgG同时阳性者阳性率、ASCA-IgG阳性率与LDC、IBD、健康对照组比较差异均无统计学意义（均P ＞0.05）,但ASCA-IgG亚型阳性率低于IBD组中的克罗恩病患者的22.0%（P＜0.05）.在PBC患者的AMA-M2和抗SP100抗体阴、阳性组中的ASCA-IgA、IgG亚型的检出率差异无统计学意义（P ＞0.05）,抗GP210抗体阳性组中的ASCA-IgA或IgG亚型检出率高于抗GP210抗体阴性组（P＜0.05）.ASCA-IgA阳性的PBC患者组中的TBil、IgA、IgM高于阴性组,ALB低于阴性组（P＜0.05）;ASCA-IgG阴、阳性组中的PBC患者的肝脏生化、免疫学指标均无统计学意义（均P ＞0.05）.结论 ASCA-IgA或ASCA-IgG可作为PBC患者的自身抗体在血清中存在,且ASCA-IgA 亚型与PBC的发病机制中存在一定的关系,并与PBC的预后有关.