血清学抗体检测对炎症性肠病的诊断价值  

Diagnostic value of serum antibodies in inflammatory bowel disease

作　　者：李慕然[1,2] 刘艳迪[1] 郑晓莉[3] 张庆瑜[4] 

机构地区：[1]天津市人民医院消化科,300121 [2]天津中医药大学 [3]天津市人民医院检验科,300121 [4]天津医科大学总医院消化科

出　　处：《中华临床医师杂志（电子版）》2013年第6期97-100,共4页Chinese Journal of Clinicians(Electronic Edition)

摘　　要：目的测定抗酿酒酵母菌抗体(ASCA)、抗胰腺腺泡抗体(PAB)、抗小肠杯状细胞抗体(GAB)、抗中性粒细胞胞浆抗体(pANCA)在炎症性肠病(IBD)中的表达,探讨其对溃疡性结肠炎(UC)和克罗恩病(CD)的诊断价值。方法 2006年1月至2011年7月收集天津市人民医院住院患者510例,分成UC组、CD组及对照组,UC组358例,男192例,女166例,平均年龄(45.7±15.8)岁,CD组31例,男20例,女11例,平均年龄(42.8±19.2)岁,对照组121例,男69例,女52例,平均年龄(56.8±13.2)岁。空腹采集静脉血2ml,采用间接免疫荧光法检测血清中IgA型和IgG型ASCA、PAB、GAB和pANCA4种抗体的表达。结果 ASCA-IgA和IgG1种以上亚型阳性在CD组、UC组和对照组阳性率分别为12.9%、3.6%、1.7%,CD组与后两组比较差异有统计学意义。PAB各组无一例阳性表达。GAB在UC组和CD组比较差异无统计学意义。pANCA在UC组中阳性率为54.7%,显著高于CD组(3.2%)和对照组(2.5%),UC组和后两组比较差异有统计学意义。ASCA(+)诊断CD的敏感性、特异性、阳性和阴性预测值分别为12.9%、96.4%、23.5%、92.7%,pANCA(+)诊断UC的敏感性、特异性、阳性和阴性预测值分别为54.7%、96.8%、99.5%、15.6%。结论 IBD相关抗体检测的特异性较高,但敏感性低。pANCA对于诊断UC较有价值,同时检测IgA型和IgG型ASCA可提高CD诊断的敏感性,PAB对于诊断IBD意义不大。Objective To determine the serum levels of anti-saccharomyces cerevisia antibody（ASCA）,anti-pancreatic antibody（PAB）,anti-intestinal goblet cell antibody （GAB）,pemuclear anti-neutrophil cytoplasmic antibody（pANCA） in inflammatory bowel disease（IBD） and to evaluate their diagnostic value in ulcerative colitis （UC）and Crohn＇s disease（CD）.Methods Serum samples were obtained from 358 patients with UC,31 patients with CD,121 patients with controls.ASCA-IgA,ASCA-IgG,PAB,GAB,pANCA were detected by indirect immunofluorescence assay.Results The positive rate of one of ASCA-IgA and ASCA-IgG in CD was 12.9％,higher than that of UC and the control group.There was no PAB expressed in all of groups.The positive rate of pANCA in UC were 54.7％,significantly higher than those in other groups.GAB had no significant difference between UC and CD.The sensibility,specificity,positive and negative predictive value of ASCA for the diagnosis of CD were 12.9％,96.4％,23.5％ and 92.7％.The sensibility,specificity,positive and negative predictive value of pANCA for the diagnosis of UC were 54.7％,96.8％,99.5％ and 15.6％.Conclusions Serum auto-antibody detection shows high specificity but low sensitivity in the diagnosis of IBD.pANCA is useful to the diagnosis of UC.Combined testing of ASCA-IgA with IgG can improve the sensitivity in screening CD patients.The low positive rates of PAB render them of little value in diagnosis of IBD.

关 键 词：炎性肠疾病 抗体 抗中性白细胞胞质 抗小肠杯状细胞抗体 抗胰外分泌腺抗体 抗酿酒酵母菌抗体 

分 类 号：R574[医药卫生—消化系统]