Solberg Inger Camilla, Lygren Idar, Cvancarova Milada, Jahnsen Jørgen, Stray Njaal, Sauar Jostein, Schreiber Stefan, Moum Bjørn, Vatn Morten H
Department of Gastroenterology, Ullevål University Hospital, Oslo, Norway.
Inflamm Bowel Dis. 2009 Mar;15(3):406-14. doi: 10.1002/ibd.20781.
Perinuclear antineutrophil cytoplasmic antibodies (pANCA) and anti-Saccharomyces cerevisiae antibodies (ASCA) are proposed to be specific markers for ulcerative colitis (UC) and Crohn's disease (CD). Their prevalence and relationship to disease phenotype and outcome in unselected cohorts of patients with inflammatory bowel disease (IBD), however, is largely unclear. We studied the prevalence of these serologic markers in a population-based IBD cohort 10 years after diagnosis, and examined whether their presence could be related to distinct subgroups and outcome of disease.
Of 685 living IBD patients, 620 met for a 10-year follow-up, of whom 526 (UC, n = 357 and CD, n = 169) participated in this study.
Twenty-seven percent (n = 46) of CD patients were ASCA-positive and 31% (n = 109) of UC patients were pANCA-positive. Positive ASCA was more frequent in CD patients with stricturing (P = 0.003) or penetrating (P = 0.012) complications than in those with inflammatory behavior at diagnosis. Moreover, the presence of ASCA was associated with an at least twice higher risk of evolving more severe disease behavior during follow-up (P < 0.001). In UC, pANCA expression was related to female gender (P = 0.005) and the use of azathioprine (P < 0.001), and in CD, to colon-limited disease and age >/=40 years at diagnosis (P = 0.009 and P = 0.001, respectively).
The prevalence of ASCA in CD and pANCA in UC appears markedly lower than in referral-based populations. Even with the low prevalence, our study gives further support to the role of ASCA and pANCA as markers for distinct phenotype and outcome of disease.
核周型抗中性粒细胞胞浆抗体（pANCA）和抗酿酒酵母抗体（ASCA）被认为是溃疡性结肠炎（UC）和克罗恩病（CD）的特异性标志物。然而，在未经选择的炎症性肠病（IBD）患者队列中，它们的患病率以及与疾病表型和结局的关系在很大程度上尚不清楚。我们研究了这些血清学标志物在诊断后10年的基于人群的IBD队列中的患病率，并检查它们的存在是否与不同的亚组和疾病结局相关。
在685名存活的IBD患者中，620名接受了10年随访，其中526名（UC患者357名，CD患者169名）参与了本研究。
27%（n = 46）的CD患者ASCA呈阳性，31%（n = 109）的UC患者pANCA呈阳性。与诊断时具有炎症表现的CD患者相比，有狭窄（P = 0.003）或穿透性（P = 0.012）并发症的CD患者中ASCA阳性更为常见。此外，ASCA的存在与随访期间病情发展为更严重疾病行为的风险至少高出两倍相关（P < 0.001）。在UC中，pANCA表达与女性性别（P = 0.005）和硫唑嘌呤的使用（P < 0.001）有关，而在CD中，与结肠局限性疾病和诊断时年龄≥40岁有关（分别为P = 0.009和P = 0.001）。
CD中ASCA和UC中pANCA的患病率似乎明显低于基于转诊的人群。即使患病率较低，我们的研究进一步支持了ASCA和pANCA作为不同疾病表型和结局标志物的作用。
