血清PAB、ASCA、ANCA和GAB单项或联合检测在炎症性肠病诊断中的价值  

Value of single or combined detection of serum PAB,ASCA,ANCA and GAB in diagnosis of inflammatory bowel disease

作　　者：罗婷 曾俊祥 高莉梅 余悠悠[1] 潘秀军[1] LUO Ting;ZENG Junxiang;GAO Limei;YU Youyou;PAN Xiujun(Department of Clinical Laboratory,Xinhua Hospital,School of Medicine,Shanghai Jiao Tong University,Shanghai 200092,China)

机构地区：[1]上海交通大学医学院附属新华医院检验科,200092

出　　处：《国际消化病杂志》2023年第1期32-38,共7页International Journal of Digestive Diseases

摘　　要：目的评估血清抗胰腺腺泡抗体(PAB)、抗酿酒酵母抗体(ASCA)、抗中性粒细胞胞浆抗体(ANCA)和抗小肠杯状细胞抗体(GAB)的IgG和IgA在IBD诊断及鉴别诊断中的临床价值。方法选择2019年6月至2021年3月在上海交通大学医学院附属新华医院确诊的165例IBD患者,以及同期就诊的145例其他消化道疾病患者作为研究对象。采用间接免疫荧光法检测血清中PAB、ASCA、ANCA和GAB的IgG和IgA。比较各组的抗体阳性率,以及抗体单项和联合检测在IBD诊断及鉴别诊断中的效能。比较不同临床表型的CD患者的血清ASCA表达情况。结果PAB、ASCA、ANCA的IgG和(或)IgA阳性率在IBD组与非IBD组、CD组与UC组之间的差异均有统计学意义(P均<0.05),而GAB的IgG和IgA阳性率在各组间差异均无统计学意义(P均>0.05)。ASCA IgG阳性率在CD组与UC组间差异无统计学意义(P>0.05)。单项检测PAB、ASCA、ANCA的IgG和(或)IgA用于鉴别诊断IBD与非IBD疾病、CD与UC时,PAB IgG的约登指数和阳性似然比均最高。抗体单项、两两和3项联合检测用于鉴别诊断IBD与非IBD疾病时,PAB IgG与ANCA IgG联合检测的约登指数和阳性似然比均最高;用于鉴别CD与UC时,单项检测PAB IgG的阳性似然比最高。ASCA IgG阳性与阴性的患者在吸烟史、确诊年龄、免疫抑制剂治疗及肠道手术史患者中占比的差异均无统计学意义(P均>0.05),但在男性CD患者中占比的差异有统计学意义(P<0.05)。在上述临床表型的CD患者中,ASCA IgA阳性与阴性的患者占比的差异均无统计学意义(P均>0.05)。结论PAB IgG与ANCA IgG联合检测适用于IBD的诊断,PAB IgG单项检测适用于CD与UC的鉴别诊断。ASCA IgG适用于IBD的诊断,而ASCA IgA适用于CD与UC的鉴别诊断。GAB可能不适用于中国人群。Objective This paper aims to evaluate the clinical value of serum anti-pancreas acinar antibody(PAB),anti-saccharomyces cerevisiae antibody(ASCA),anti-neutrophil cytoplasmic antibody(ANCA),and anti-intestine goblet cell antibody(GAB)IgG and IgA in the diagnosis and differential diagnosis of inflammatory bowel disease(IBD).Methods One hundred and sixty-five patients with IBD diagnosed in Xinhua Hospital Affiliated to Shanghai Jiao Tong University Medical College from June 2019 to March 2021,and 145 patients with other digestive tract diseases were selected as the study subjects.The IgG and IgA of PAB,ASCA,ANCA,and GAB in the serum were detected by utilizing the indirect immunofluorescence method.The antibody positive rate of each group and the efficacy of single and combined antibody detection in the diagnosis and differential diagnosis of IBD were compared.The expression of ASCA in the serum of CD patients with different clinical phenotypes was compared.Results There are significant differences in the positive rates of IgG and/or IgA of PAB,ASCA,and ANCA between the IBD group and the non-IBD group,the CD group and the UC group(P<0.05).However,there are no significant differences between the positive rates of IgG and IgA of GAB among these groups(P>0.05).There is no significant difference in the positive rate of ASCA IgG between the CD group and the UC group(P>0.05).When the IgG and/or IgA of PAB,ASCA and ANCA are tested individually to identify IBD and non-IBD diseases,CD and UC,the Yoden index and positive likelihood ratio of PAB IgG are the highest.When single,pairwise,and three combined antibody tests are conducted to identify IBD and non-IBD diseases,the Joden index and positive likelihood ratio of the combined detection of PAB IgG and ANCA IgG are the highest.When identifying CD and UC,the positive likelihood ratio of PAB IgG in a single test is the highest.There are no statistically significant differences in the proportion of ASCA IgG positive and negative patients in the smoking history,age,immunosuppress

关 键 词：炎症性肠病 抗中性粒细胞胞浆抗体 抗酿酒酵母抗体 抗小肠杯状细胞抗体 抗胰腺腺泡抗体 

分 类 号：R574[医药卫生—消化系统]