Department of Laboratory Diagnosis, University Medical Center Maribor, Maribor, Slovenia.
Wien Klin Wochenschr. 2010 May;122 Suppl 2:19-25. doi: 10.1007/s00508-010-1344-y.
The diagnosis of inflammatory bowel disease (IBD), particularly the differentiation between ulcerative colitis (UC) and Crohn's disease (CD), is difficult and delayed in many cases, despite invasive diagnostic tools.
To determine the presence and evaluate the diagnostic accuracy of the potential serological diagnostic markers perinuclear antineutrophil cytoplasmic antibodies (pANCA), autoantibodies to intestinal goblet cells (GAB) and autoantibodies to exocrine pancreas (PAB), together with combinations of these, in the diagnosis of IBD and differential diagnosis of UC and CD.
The presence of pANCA, GAB and PAB was determined in indirect immunofluorescence assay of serum samples from 71 patients with IBD (CD 43, UC 28) and 41 healthy controls. The antigen specificity of ANCA was determined using ELISA.
Compared with the control group, we confirmed a statistically significant presence of pANCA (71.4%) and GAB (46.4%) in patients with UC and the presence of PAB only in patients with CD (30.2%) (P < 0.001). In healthy controls, neither PAB nor GAB was detected and pANCA was present in only 4.8%. The sensitivity, specificity and positive and negative predictive values in differentiation of IBD from healthy controls were as follows: pANCA(+): 71%, 95%, 91%, 83%; GAB(+): 46%, 100%, 100%, 73%; PAB(+): 30%, 100%, 100%, 58%; combination of (pANCA(+) or GAB(+))/PAB(-): 82%, 95%, 92%, 87%; and to distinguish UC from CD: pANCA(+): 71%, 98%, 95%, 84%; GAB(+): 46%, 98%, 93%, 74%; PAB(+): 30%, 100%, 100%, 48%; (pANCA(+) or GAB(+))/PAB(-): 82%, 98%, 96%, 89%.
All three autoantibodies may be helpful tools in non-invasive diagnosis and differential diagnosis of UC and CD. Combination of the autoantibodies may be particularly helpful, as the diagnostic sensitivity is considerably improved.
炎症性肠病（IBD）的诊断，特别是溃疡性结肠炎（UC）和克罗恩病（CD）的鉴别诊断，尽管有侵袭性诊断工具，但在许多情况下仍很困难且延误。
确定潜在的血清学诊断标志物核周抗中性粒细胞胞质抗体（pANCA）、肠杯状细胞自身抗体（GAB）和外分泌胰腺自身抗体（PAB）以及它们的组合在 IBD 诊断和 UC 和 CD 鉴别诊断中的存在情况，并评估其诊断准确性。
采用间接免疫荧光法检测 71 例 IBD 患者（CD43 例，UC28 例）和 41 例健康对照者血清中 pANCA、GAB 和 PAB 的存在情况。使用 ELISA 法确定 ANCA 的抗原特异性。
与对照组相比，我们在 UC 患者中证实了 pANCA（71.4%）和 GAB（46.4%）的统计学显著存在，而仅在 CD 患者中存在 PAB（30.2%）（P<0.001）。在健康对照组中，既没有检测到 PAB 也没有检测到 GAB，而 pANCA 仅存在于 4.8%的患者中。与健康对照组相比，IBD 的鉴别诊断的敏感性、特异性和阳性及阴性预测值如下：pANCA（+）：71%，95%，91%，83%；GAB（+）：46%，100%，100%，73%；PAB（+）：30%，100%，100%，58%；（pANCA（+）或 GAB（+））/PAB（-）：82%，95%，92%，87%；UC 与 CD 鉴别诊断：pANCA（+）：71%，98%，95%，84%；GAB（+）：46%，98%，93%，74%；PAB（+）：30%，100%，100%，48%；（pANCA（+）或 GAB（+））/PAB（-）：82%，98%，96%，89%。
三种自身抗体均可作为 UC 和 CD 非侵入性诊断和鉴别诊断的有用工具。自身抗体的组合可能特别有帮助，因为诊断敏感性有了显著提高。
