联合多种自身抗体检测对炎症性肠病的诊断价值研究  

Diagnostic value of serum autoantibodies in patients with inflammatory bowel disease

作　　者：黎安玲[1] 杨桂[1] 杨钢[1] 夏琳[1] 

机构地区：[1]武汉大学中南医院检验科,武汉430071

出　　处：《临床血液学杂志（输血与检验）》2018年第1期116-119,共4页Journal of Clinical Hematology(Blood Transfusion & Laboratory Medicine)

摘　　要：目的:联合检测核周型抗中性粒细胞胞浆抗体(pANCA)、抗酿酒酵母菌抗体(ASCA)、抗胰外分泌腺抗体(PAB)和抗小肠杯状细胞抗体(GAB)在炎症性肠病(IBD)中的表达,以探讨其对炎症性肠病中的克罗恩病(CD)和溃疡性结肠炎(UC)的诊断与鉴别诊断价值。方法:空腹采集静脉血2ml,用间接免疫荧光法测定113例UC组、96例CD组、43例肠道疾病对照组及20例正常对照组血清pANCA、ASCA、PAB、GAB的表达。结果:在4个组中,UC组的pANCA阳性率为40.7%,明显高于其他3组(P<0.01)。ASCA在UC组与CD组的阳性率分别为5.3%和4.2%,2组之间及与疾病对照组、正常对照组比较均无显著性差异(P>0.05)。GAB在UC组及CD组的阳性率分别为13.3%和12.5%,2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有显著性意义(P<0.05)。PAB各组无一例阳性。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41.6%、96.8%、97.8%和33.3%。pANCA+/ASCA-诊断UC的敏感性和特异性为40.7%和96.8%,pANCA-/GAB+诊断CD的敏感性和特异性为11.5%和100%。结论:炎症性肠病相关抗体检测的特异性高,但敏感性低,联合检测能显著提高敏感性。pANCA对UC的诊断和鉴别诊断有意义,GAB对IBD的诊断较有意义,而ASCA和PAB对IBD的诊断价值不大。联合检测pANCA和GAB,可用于UC和CD的鉴别诊断。Objective：To combined detect the serum levels of pernuclear anti-neutrophil cytoplasmic antibody（pANCA）,anti-saccharomyces cerevisia antibody（ASCA）,anti-pancreatic antibody（PAB）and anti-intestinal goblet cell antibody（GAB）in inflammatory bowel disease（IBD）and discuss their diagnostic and differential diagnostic value in Crohn＇s disease（CD）and ulcerative colitis（UC）.Method：Fasting blood serum samples were obtained from 113 patients with UC,96 patients with CD,43 patients with other intestinal illness as disease controls and 20 normal controls.pANCA,GAB,PAB and ASCA were detected by indirect immunofluorescence assay.Result：The pANCA positive rate in UC group was 40.7%,which was significantly higher than that in the other three groups（P〉0.05）.The positive rate of ASCA in UC and CD were 5.3% and 4.2%respectively,and there were no significant difference between CD group and UC group or control groups（P〈0.05）.The positive rate of GAB in UC and CD were 13.3% and 12.5%,and there was no significant difference between CD group and UC group（P〉0.05）,but higher than those in other control groups（P〈0.05）.PAB was not positive in all of groups.The sensibility,specificity,positive and negative predictive value of combined detection of four auto-antibodies for the diagnosis of IBD were 41.6%,96.8%,97.8% and 33.3%,respectively.The combination of a positive pANCA and a negative ASCA test for the diagnosis of UC yielded a sensitivity and specificity of 40.7%and 96.8%.The combination of a negative pANCA and a positive GAB test for the diagnosis of CD yielded a sensitivity and specificity of 11.5% and 100%.Conclusion：Serum auto-antibody detection showed high specificity but low sensitivity in the diagnosis of IBD.The combination of tests could greatly improve the sensitivity for diagnosis.pANCA may be useful to the diagnosis and differential diagnosis of UC,and GAB be useful to the diagnosis of IBD.But the low positive rates of ASCA and PAB render them of little value in dia

关 键 词：炎症性肠病 核周型抗中性粒细胞胞浆抗体 抗酿酒酵母菌抗体 抗胰外分泌腺抗体 抗小肠杯状细胞抗体 

分 类 号：R512.5[医药卫生—内科学]