不同血清学标志物在炎症性肠病中的诊断价值以及与疾病表型的关联分析  

Diagnostic value of different serological markers and correlation analysis with disease phenotype in inflammatory bowel disease

作　　者：唐颢[1] 谭蓓[1] 沈冰冰[1] 张蜀澜[2] 钱家鸣[1] Tang Hao;Tan Bei;Shen Bingbing;Zhang Shulan;Qian Jiaming(Department of Gastroenterology,Peking Union Medical College Hospital,Chinese Academy of Medical Science&Peking Union Medical College,Beijing 100730,China;Department of Rheumatology and Immunology,Peking Union Medical College Hospital,Chinese Academy of Medical Science&Peking Union Medical College,Beijing 100730,China)

机构地区：[1]中国医学科学院,北京协和医学院,北京协和医院消化内科,北京100730 [2]中国医学科学院,北京协和医学院,北京协和医院风湿免疫科,北京100730

出　　处：《中华医学杂志》2022年第47期3743-3748,共6页National Medical Journal of China

基　　金：中央高水平医院临床科研业务费资助项目(2022-PUMCH-A-160);卫生部行业专项基金(201002020,201502005);国家自然科学基金(82000526)。

摘　　要：目的探讨不同血清学标志物在炎症性肠病(IBD)中的诊断价值,并分析其与疾病表型的关联。方法回顾性收集2010年6月至2020年12月北京协和医院445例IBD患者的临床资料,其中溃疡性结肠炎(UC)223例[男111例,女112例,年龄46(20,79)岁],克罗恩病(CD)222例[男147例,女75例,年龄39(19,72)岁]。分别分析两组患者血清抗中性粒细胞胞浆抗体(ANCA)、抗酿酒酵母抗体(ASCA)、抗杯状细胞抗体(GAB)、抗胰腺腺泡抗体(PAB)的阳性率;计算不同组合抗体诊断UC和CD的灵敏度、特异度、阳性预测值和阴性预测值;通过logistic回归分析不同组合抗体与疾病表型的关联。结果CD患者血清ASCA、PAB阳性率分别为34.7%(77/222)、38.3%(85/222),均高于UC患者的10.3%(23/223)、4.5%(10/223)(均P<0.001)。UC患者血清ANCA阳性率为50.2%(112/223),高于CD患者的5.4%(12/222)(P<0.001)。CD和UC患者血清GAB阳性率分别为21.6%(48/222)、28.3%(63/223),差异无统计学意义(P=0.760)。单项ASCA(+)、双联ASCA(+)ANCA(-)、四联ASCA(+)ANCA(-)PAB(+)GAB(-)诊断CD的灵敏度分别为34.7%、32.9%、20.7%,特异度分别为89.7%、95.5%、100.0%,阳性预测值分别为77.0%、90.1%、100.0%,阴性预测值分别为58.0%、58.7%、55.9%;单项ANCA(+)、双联ANCA(+)ASCA(-)、四联ANCA(+)ASCA(-)PAB(-)GAB(+)诊断UC的灵敏度分别为50.2%、40.4%、24.2%,特异度分别为94.6%、95.5%、100.0%,阳性预测值分别为90.3%、90.0%、100.0%,阴性预测值分别为65.4%、61.4%、56.8%。单项ASCA(+)(OR=3.39,95%CI:1.59~7.21)、双联ASCA(+)ANCA(-)(OR=2.87,95%CI:1.34~6.14)、三联ASCA(+)ANCA(-)GAB(-)(OR=3.09,95%CI:1.31~7.31)和四联标志物ASCA(+)ANCA(-)PAB(+)GAB(-)(OR=3.15,95%CI:1.56~8.03)与狭窄型和(或)穿通型CD有关联;而单项标志物ANCA(+)(OR=2.69,95%CI:1.42~5.12)、双联ANCA(+)ASCA(-)(OR=2.11,95%CI:1.03~4.16)与UC广泛结肠病变有关联。结论以ASCA或ANCA为基础,联合PAB或GAB检测有助于IBD诊断,且与狭窄型和(或)穿通型CD、广泛结肠型UC有关Objective To explore the diagnostic value of different serological markers and the correlation with disease phenotype in inflammatory bowel disease(IBD).Methods The clinical data of 445 IBD patients in Peking Union Medical College Hospital from June 2010 to December 2020 were retrospectively collected,including 223 cases of ulcerative colitis(UC)[111 males,112 females,with a median age of 46(20,79)years]and 222 cases of Crohn′s disease(CD)[147 males,75 females,with a median age of 39(19,72)years].The positive rates of serum anti-neutrophil cytoplasmic antibodies(ANCA),anti-Saccharomyces cerevisiae antibodies(ASCA),goblet cell autoantibodies(GAB)and pancreatic autoantibodies(PAB)in the two groups were analyzed.The sensitivity,specificity,positive predictive value and negative predictive value of UC and CD were calculated.Logistic regression was performed to analyze the relationship between different combinations of antibodies and disease phenotype.Results The positive rates of ASCA and PAB in CD patients were 34.7%(77/222)and 38.3%(85/222),respectively,which were higher than those in UC patients[10.3%(23/223)and 4.5%(10/223),P<0.001].The positive rate of ANCA in UC patients was 50.2%(112/223),which was higher than that in CD patients[5.4%(12/222),P<0.001].The positive rates of serum GAB in CD and UC patients were 21.6%(48/222)and 28.3%(63/223),respectively,with no significant difference(P=0.760).In patients with CD,the sensitivity of mono-marker ASCA(+),dual-marker ASCA(+)ANCA(-),quadruple-marker ASCA(+)ANCA(-)PAB(+)GAB(-)in diagnosing CD was 34.7%,32.9%,20.7%,the specificity was 89.7%,95.5%,100.0%,the positive predictive value was 77.0%,90.1%,100.0%,and the negative predictive value was 58.0%,58.7%,55.9%,respectively.In patients with UC,the sensitivity of mono-marker ANCA(+),dual-marker ANCA(+)ASCA(-),quadruple-marker ANCA(+)ASCA(-)PAB(-)GAB(+)in diagnosing UC was 50.2%,40.4%,24.2%,the specificity was 94.6%,95.5%,100.0%,the positive predictive value was 90.3%,90.0%,100.0%,and the negative predictive value was 6

关 键 词：炎性肠病 血清标志物 诊断 疾病行为 横断面研究 

分 类 号：R574[医药卫生—消化系统]