炎症性肠病患者中四种自身抗体联合检测的临床意义  

Clinical Significance of Combined Assays of Four Auto-antibodies in Inflammatory Bowel Disease

作　　者：何淳[1] 张蜀澜[1] 李永哲[1] 张海莹[1] 佟大伟[1] 胡朝军[1] 

机构地区：[1]中国医学科学院北京协和医学院北京协和医院检验科,北京100730

出　　处：《标记免疫分析与临床》2008年第5期268-271,337,共5页Labeled Immunoassays and Clinical Medicine

基　　金：国家自然科学基金资助项目(No.30640084;No.30471617)

摘　　要：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。To assess the value of combined assays of anti-neutrophil cytoplasmic antibody （ANCA）, antisaeeharomyces cerevisiae antibody （ASCA） anti-intestinal goblet cell antibody （IGA） and anti-pancreatie antibody （ PAB ） in diagnosis of 20 patients with ulcerative colitis （ UC group ）, 20 patients with Crohn＇ s disease （ CD group） and differentiation UC from CD, the serum levels of ANCA, ASCA, IGA and PAB in patients with inflammatory bowel disease （IBD）, 10 patients with other intestinal disease and 5 normal volunteers were detected by indirect immunofluorescenee assay. The results showed that the positive rate of ANCA in patients with UC ,CD, other intestinal disease and control group were 70%, 25%, 10% and 0% respectively. The value in UC group was significantly higher than that of the other three groups （P 〈 0.05）. The ASCA positive rates were 15%, 60%, 10% and 0% respectively. The value in CD group was significantly higher than that of the other three groups （P 〈 0.05）. The IGA positive rates were 30%, 65%, 10% and 0% respectively. The value in CD group was also significantly higher than that of two control groups （P 〈 0.05）, but there was not significant difference with the UC group （P 〉 0. 05）. The sensibility, specificity, positive and negative predictive value of combination of positive ANCA and negative ASCA in the diagnosis of UC were 55% ,90% ,84.6% and 66.7% respectively, and those of combination of positive ASCA and negative ANCA in the diagnosis of CD were 35%, 95%, 87.5% and 59.4% respectively. The sensibility, specificity, positive and negative predictive value of combination of positive IGA and negative ANCA in the diagnosis of CD were 45%, 95% , 90% and 63.3% respectively. The positive values of ANCA, ASCA and IGA were useful in the diagnosis of IBD, but were not enough sensible to screen the IBD. The combined detection of ANCA, ASCA, and IGA could be as one of serum differential diagnosis markers for IBD.

关 键 词：克罗恩病 溃疡性结肠炎 抗酿酒酵母菌抗体 抗中性粒细胞胞浆抗体 抗小肠杯状细胞抗体 抗胰腺腺泡抗体 

分 类 号：R574.62[医药卫生—消化系统]