Elitsur Yoram, Lawrence Zandra, Tolaymat Naser
Department of Pediatrics, Sections of Gastroenterology, Marshall University, Joan C. Edwards School of Medicine, Huntington, WV 25701, USA.
J Clin Gastroenterol. 2005 Sep;39(8):670-3. doi: 10.1097/01.mcg.0000173853.78042.2d.
To assess the sensitivity/specificity of the serologic markers: perinuclear antineutrophil cytoplasmic antibody (pANCA) and anti-saccharomyces cerevisiae antibody (ASCA) in children diagnosed with inflammatory bowel disease (IBD), living in West Virginia.
In recent years, serologic markers have been used to differentiate between CD and UC diseases in children. The clinical usefulness of these markers in children was restricted by their low sensitivity and specificity. Racial and ethnic diversity may alter the accuracy of these markers in children. The demographic homogeneity of the West Virginia population may offer a better clinical setup to reassess the utility of those markers in children with IBD.
A retrospective analysis of all the charts of children diagnosed with IBD was performed at the gastroenterology clinics of Marshall University, Huntington, WV; and West Virginia University, Charleston Division, Charleston, WV. The diagnosis of IBD was established according to clinical, radiologic, and endoscopic data. Laboratory data and serum markers were recorded, and their accuracy to diagnose UC or CD was assessed.
A total of 101 charts were reviewed, of which only 90 (89%) included serologic markers and were considered for further analysis. Disease distribution included: UC-41, CD-44, and indeterminate colitis (IC)-7 (2 patients changed diagnosis after colectomy). Serum antibody pANCA had a sensitivity of 73% and specificity of 84% for UC, but only 16% and 35% for CD, respectively. Serum antibody ASCA had a sensitivity of 58% and specificity of 92% for CD, but only 7% and 49% for UC, respectively. The outer membrane porin to Escherichia coli antibody (anti-OmpC) was available in 54 (59%) children and demonstrated a very poor sensitivity for both diseases (sensitivity<11%).
Despite our homogeneous patient population, pANCA and ASCA antibodies had an inadequate sensitivity/specificity for children with UC or CD. Those antibodies were not useful for our small number of patients with IC.
评估血清学标志物——核周型抗中性粒细胞胞浆抗体（pANCA）和抗酿酒酵母抗体（ASCA）在西弗吉尼亚州被诊断为炎症性肠病（IBD）的儿童中的敏感性/特异性。
近年来，血清学标志物已被用于区分儿童的克罗恩病（CD）和溃疡性结肠炎（UC）。这些标志物在儿童中的临床实用性受到其低敏感性和特异性的限制。种族和民族多样性可能会改变这些标志物在儿童中的准确性。西弗吉尼亚州人口的人口统计学同质性可能为重新评估这些标志物在IBD儿童中的效用提供更好的临床环境。
对在西弗吉尼亚州亨廷顿的马歇尔大学胃肠病诊所以及西弗吉尼亚大学查尔斯顿分校查尔斯顿诊所被诊断为IBD的所有儿童病历进行回顾性分析。IBD的诊断根据临床、放射学和内镜检查数据确定。记录实验室数据和血清标志物，并评估其诊断UC或CD的准确性。
共审查了101份病历，其中只有90份（89%）包含血清学标志物并被纳入进一步分析。疾病分布包括：UC-41例，CD-44例，不确定结肠炎（IC）-7例（2例患者在结肠切除术后改变诊断）。血清抗体pANCA对UC的敏感性为73%，特异性为84%，但对CD的敏感性分别仅为16%，特异性为35%。血清抗体ASCA对CD的敏感性为58%，特异性为92%，但对UC的敏感性分别仅为7%，特异性为49%。54名（59%）儿童有抗大肠杆菌外膜孔蛋白抗体（抗OmpC），对两种疾病的敏感性都很差（敏感性<11%）。
尽管我们的患者群体具有同质性，但pANCA和ASCA抗体对UC或CD儿童的敏感性/特异性不足。这些抗体对我们少数IC患者无用。
