Sładek Małgorzata, Wasilewska Agata, Swiat Agnieszka, Cmiel Adam
Department of Paediatrics, Gastroenterology and Nutrition, Jagiellonian University Medical College, Krakow, Poland.
Department of Applied Mathematics, AGH University of Science and Technology, Krakow, Poland.
Prz Gastroenterol. 2014;9(4):232-41. doi: 10.5114/pg.2014.45106. Epub 2014 Sep 16.
Antibodies reacting with various microbial epitopes have been described in inflammatory bowel disease (IBD) and are associated with a specific diagnosis and clinical presentation.
To evaluate the profile of new anti-glycan antibodies, their potential association with disease phenotype and diagnostic accuracy in paediatric Crohn's disease (CD).
Blood samples from 134 paediatric IBD patients (109 CD, 25 ulcerative colitis (UC)) and 67 controls were blindly analysed for anti-Saccharomyces cerevisiae (ASCA), anti-chitobioside carbohydrate (ACCA), anti-laminaribioside carbohydrate (ALCA), and anti-mannobioside carbohydrate (AMCA) antibodies using commercially available assays. The serological response to glycans was correlated with clinical disease characteristics.
At least one of the tested anti-glycan antibodies was present in 75% of CD patients. Despite the high frequency of reactivity to glycan epitopes, a limited overlap of serological markers was observed. In total, 49% of ASCA-negative patients presented with one of the following: ACCA, ALCA, or AMCA. The occurrence of one antibody from the anti-glycan panel was independently associated with complicated disease phenotype and ileocolonic disease location. A higher level of immune response as assessed by the quartile sum scores for ACCA, ALCA, and AMCA was linked with older age at diagnosis (10-17 years) and ileocolonic disease location. The ASCA had the greatest accuracy for diagnosis and differentiation of CD.
Qualitative and quantitative serologicalal response to glycan epitopes was associated with distinct clinical presentation in paediatric CD patients. This raises the possibility for the use of these markers to differentiate subgroups of CD patients with more sever clinical presentation. The ASCA was the most accurate serological marker for CD; however, testing for the new anti-glycan antibodies may constitute an adjunctive tool in a specific group of patients to aid in the differentiation of CD with absent ASCA from ulcerative colitis.
在炎症性肠病（IBD）中已发现与各种微生物表位发生反应的抗体，这些抗体与特定诊断及临床表现相关。
评估新型抗聚糖抗体的特征、其与疾病表型的潜在关联以及在儿童克罗恩病（CD）中的诊断准确性。
采用市售检测方法，对134例儿童IBD患者（109例CD、25例溃疡性结肠炎（UC））及67例对照的血样进行抗酿酒酵母（ASCA）、抗壳二糖苷碳水化合物（ACCA）、抗层粘连二糖苷碳水化合物（ALCA）和抗甘露二糖苷碳水化合物（AMCA）抗体的盲法分析。对聚糖的血清学反应与临床疾病特征进行关联分析。
75%的CD患者存在至少一种检测的抗聚糖抗体。尽管对聚糖表位的反应频率较高，但血清学标志物的重叠有限。总体而言，49%的ASCA阴性患者出现以下情况之一：ACCA、ALCA或AMCA。抗聚糖组中一种抗体的出现与复杂疾病表型及回结肠疾病部位独立相关。根据ACCA、ALCA和AMCA的四分位数总和评分评估的较高免疫反应水平与诊断时年龄较大（10 - 17岁）及回结肠疾病部位相关。ASCA在CD的诊断和鉴别中准确性最高。
对聚糖表位的定性和定量血清学反应与儿童CD患者的不同临床表现相关。这增加了使用这些标志物区分临床表现更严重的CD患者亚组的可能性。ASCA是CD最准确的血清学标志物；然而，检测新型抗聚糖抗体可能在特定患者群体中构成辅助工具，以帮助鉴别无ASCA的CD与溃疡性结肠炎。
