Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada.
Clin Gastroenterol Hepatol. 2012 May;10(5):507-12.e1. doi: 10.1016/j.cgh.2011.09.016. Epub 2011 Oct 1.
BACKGROUND & AIMS: Pouchitis and Crohn's disease (CD)-like (CDL) complications of the pouch occur at rates near 50% and 20%, respectively, after colectomy with ileal pouch-anal anastomosis (IPAA) for ulcerative colitis (UC). We investigated whether antimicrobial antibodies are associated with pouch outcome after IPAA.
We studied clinical and endoscopic data from 399 individuals with UC who underwent colectomy with IPAA at Mount Sinai Hospital in Toronto, Canada; patients were classified as no pouchitis (NP), chronic pouchitis (CP), or CDL. Serum samples were analyzed from 341 patients for antibodies against Saccharomyces cerevisiae (ASCA), OmpC, CBir1, and perinuclear antineutrophil cytoplasmic antibody (pANCA).
Of the subjects, 70.7% had NP, 16.8% developed CP, and 12.5% developed CDL. Smoking was associated with CDL (P = .003). Ashkenazi Jewish individuals more commonly had CP (P = .008). Of patients with CDL, 53.5% and 14.0% had positive test results for anti-CBir1 and ASCA (immunoglobulin G), respectively, compared with 21.4% and 3.8% of those with NP and 28.3% and 5.0% of those with CP (P < .0001 and P = .03). Anti-CBir1 was associated with CDL, compared with NP (P = 2.8 × 10(-5); odds ratio [OR], 4.2; 95% confidence interval [CI], 2.2-8.3) or CP (P = .011; OR, 2.9; 95% CI, 1.3-6.6). ASCA immunoglobulin G was associated with CDL, compared with patients with NP (P = .01; OR, 4.1; 95% CI, 1.4-12.3). In a combined model, pANCA and the antimicrobial antibodies were associated with CP (P = .029) and CDL (P = 4.7 × 10(-4)).
Antimicrobial antibodies and pANCA are associated with inflammatory complications of the pouch. The CDL phenotype is associated with factors that characterize Crohn's disease, including smoking, anti-CBir1, and ASCA.
在溃疡性结肠炎患者接受回肠储袋肛管吻合术（IPAA）后，发生 pouchitis 和 pouch 相关的克罗恩病（CDL）并发症的比例分别接近 50%和 20%。我们研究了在接受 IPAA 后，抗菌抗体是否与 pouch 结局相关。
我们研究了在加拿大多伦多西奈山医院接受 IPAA 的 399 名溃疡性结肠炎患者的临床和内镜数据；患者被分为无 pouchitis（NP）、慢性 pouchitis（CP）或 CDL。对 341 名患者的血清样本进行了针对酿酒酵母（ASCA）、OmpC、CBir1 和核周抗中性粒细胞胞质抗体（pANCA）的抗体分析。
受试者中，70.7%为 NP，16.8%发展为 CP，12.5%发展为 CDL。吸烟与 CDL 相关（P=0.003）。阿什肯纳兹犹太人更常出现 CP（P=0.008）。与 NP 患者相比，CDL 患者中抗 CBir1 和 ASCA（免疫球蛋白 G）的阳性检出率分别为 53.5%和 14.0%，而 CP 患者的阳性检出率分别为 28.3%和 5.0%（P＜0.0001 和 P=0.03）。与 NP 相比，抗 CBir1 与 CDL 相关（P=2.8×10（-5）；优势比[OR]，4.2；95%置信区间[CI]，2.2-8.3）或 CP（P=0.011；OR，2.9；95% CI，1.3-6.6）。与 NP 患者相比，ASCA 免疫球蛋白 G 与 CDL 相关（P=0.01；OR，4.1；95% CI，1.4-12.3）。在联合模型中，pANCA 和抗菌抗体与 CP（P=0.029）和 CDL（P=4.7×10（-4））相关。
抗菌抗体和 pANCA 与 pouch 的炎症并发症相关。CDL 表型与克罗恩病的特征性因素有关，包括吸烟、抗 CBir1 和 ASCA。
