自身免疫性肝病抗体谱的检测及临床意义

目的分析自身免疫性肝病抗体谱检测价值。方法选择我院2019年8月至2020年7月收治的自身免疫性肝病患者,包括自身免疫性肝炎(autoimmune hepatitis,AIH)、原发性胆汁性肝病(primary biliary cholangitis,PBC)、原发性硬化胆管病(primary sclerosing cholangitis,PSC)、健康受检者,分别作为观察1组、观察2组、观察3组、对照组,各50例。采用间接免疫荧光法测定,包括血清抗核抗体(antinuclearantibodies,ANA)、抗线粒体抗体(anti-mitochondria antibody,AMA)、抗平滑肌抗体(antismooth muscle antibody,SMA),以免疫印迹法测定抗可溶性肝抗原/肝胰抗原(anti-soluble live rantigen/anti-liver specitic protein,SLA/LP)、抗肝肾微粒体抗体Ⅰ型(anti-liver-kidney microsomal antibody,LKM-Ⅰ)抗体水平,分析检测结果。结果检测后,观察1组、观察2组、观察3组血清ANA阳性率明显高于对照组,P<0.05;观察1组血清ANA阳性率高于观察2组、观察3组,P<0.05;观察2组血清AMA阳性率高于1组、观察3组、对照组,P<0.05;SMA滴度≥1/320、SLA/LP、LKM-Ⅰ阳性率方面比较,观察1组明显高于观察2组、观察3组、对照组,P<0.05。结论自身免疫性肝病发病率一直较高,抗体谱的检测临床诊断可行,利于疾病早期治疗、促进预后。

Colorectal cancer surveillance in inflammatory bowel disease: The search continues

Patients with infl ammatory bowel disease (IBD) are at increased risk for colorectal cancer (CRC). Risk factors for the development of CRC in the setting of IBD include disease duration, anatomic extent of disease, age at time of diagnosis, severity of inflammation, family history of colon cancer, and concomitant primary sclerosing cholangitis. The current surveillance strategy of surveillance colonoscopy with multiple random biopsies most likely reduces morbidity and mortality associated with IBD-related CRC. Unfortunately, surveillance colonoscopy also has severe limitations including high cost, sampling error at time of biopsy, and interobserver disagreement in histologically grading dysplasia. Furthermore, once dysplasia is detected there is disagreement about its management. Advances in endoscopic imaging techniques are already underway, and may potentially aid in dysplasia detection and improve overall surveillance outcomes. Management of dysplasia depends predominantly on the degree and focality of dysplasia, with the mainstay of management involving either proctocolectomy or continued colonoscopic surveillance. Lastly, continued research into additional chemopreventive agents may increase our arsenal in attempting to reduce the incidence of IBD-associated CRC.

Primary sclerosing cholangitis and the risk of colon neoplasia in patients with Crohn’s colitis

Background and aim:Crohn’s colitis(CC)is associated with primary sclerosing cholangitis(PSC).However the risk of colon cancer or dysplasia in CC and PSC is unclear.Our aim was to study the risk of colon neoplasia in CC in patients with and without PSC.Methods:This is a nested,case-control cohort study of all patients diagnosed with concurrent CC and PSC,seen at the Cleveland Clinic between 1985 and 2012.Forty-three patients with both CC and PSC were compared with a random sample of 159 CC controls without PSC during the same period.Results:Seven(16.3%)of 43 CC patients with PSC developed colon cancer or dysplasia,compared with 22(13.8%)of 159 controls(P=0.98).Of seven colon neoplasia cases in the PSC group,100%occurred proximal to the splenic flexure,compared with 50%(11/22)cases of colon neoplasia in controls occurring in the proximal colon(P=0.001).Based on Cox regression analysis,male gender independently increased the risk of neoplasia[hazard ratio(HR)=2.68;95%confidence interval(CI)1.30-5.54;P=0.008],as did age at CC diagnosis(HR=1.29;95%CI 1.14-1.47;P<0.001),while the use of azathioprine/6-mercaptopurine was protective(HR=0.30;95%CI 0.13-0.70;P=0.005).The presence of PSC did not increase the risk for colon neoplasia(HR=0.45;95%CI 0.18-1.13;P=0.09).Conclusions:CC patients with PSC appear not to be at increased risk of developing colon neoplasia.Among patients in our cohort with colon neoplasia and concurrent PSC,the neoplasia occurred in the proximal colon in all cases.

The presence of primary sclerosing cholangitis in patients with ileal pouch anal-anastomosis is associated with an additional risk for vitamin D deficiency

Objective:Vitamin D deficiency is common in patients with ileal pouch-anal anastomosis(IPAA)for ulcerative colitis(UC).Whether vitamin D levels are further lowered in patients with concomitant IPAA and primary sclerosing cholangitis(PSC)is not known.The aim of this study was to evaluate the presence of PSC as a risk factor for vitamin D deficiency in patients with UC and IPAA.Methods:In this case control study,74 patients with concurrent IPAA and PSC were included in the study group,and 79 patients with IPAA,but without PSC,served as controls.Forty-four variables were analyzed.Univariate analysis and multivariate analysis with stepwise logistic regression were performed.Results:A total 153 eligible patients were included,with 74(48.4%)in the study group and 79(51.6%)in the control group.Vitamin D level in the study group was 18.961.4 ng/dL compared with 30.361.7 ng/d in the control group(P=0.011).Vitamin D deficiency(≤20 ng/dL)was present in 65(42.5%)patients.PSC occurred in 49(75.4%)of the 65 patients with vitamin D deficiency.In the multivariate analysis,only the presence of PSC(odds ratio[OR]:7.56;95% confidence interval[CI]:2.39–24.08;P=0.001)and vitamin D supplementation(OR:2.58;95% CI:1.57–9.19;P=0.018)remained associated with vitamin D deficiency.Conclusion:The presence of PSC was found to be an independent risk factor for vitamin D deficiency in UC patients with IPAA.These patients should be routinely screened and closely monitored for vitamin D deficiency.