Gurina O P, Stepanova A A, Dementieva E A, Blinov A E, Varlamova O N, Blinov G A
The Federal state budget educational institution of higher education "The St. Petersburg state pediatric medical university" of Minzdrav of Russia, 194100, St. Petersburg, Russia.
Klin Lab Diagn. 2018;63(1):44-50. doi: 10.18821/0869-2084-2018-63-1-44-50.
The purpose of study is to establish features of autoimmune reaction of children with Crohn's disease. The sampling included 62 patients aged from 2 to 17 years with diagnosis of Crohn's disease. The evaluation was carried out concerning concentration in blood serum of immunoglobulins IgA, IgM, IgG, IgЕ, antibodies to Saccharomyces cerevisiae (ASCA) classes IgA, IgG и IgЕ, antibodies to Candida albicans classes IgA, IgM, IgG и IgЕ, anti-neutrophilic cytoplasmic antibodies (ANCA) to myeloperoxidase (MPO), to proteinase 3 (PR3), anti-nuclear antibodies (ANA), antibodies to DNAds, DNAss (to double-helical and single-stranded DNA), antibodies to antigens of small and large intestines, pancreas, circulating immune complexes. The hyperimmunoglobulinemia was diagnosed in 47 (75.8%) out of 62 patients with Crohn's disease. The increased level of IgM in blood was detected in 29 patients (46.8%). The hyperimmunoglobulinemia У was established in 19 (30.6%) out of 62 children. The hypoimmunoglobulinemia was detected in 22 (35.5%) of patients and in 17 (77.3%) out of them the disimmunoglobulinemia type IV (isolated decreasing of concentration of IgA). The evaluation of rate of occurrence of specifc antibodies in blood serum demonstrated that in patients most frequently was detected presence of specifc IgE to Saccharomyces cerevisiae (70.9%). The increased level of ASCA (IgA, IgG) was detected in 22 (35.5%) patients. The concentration of antibodies to DNAds, DNAss in blood exceeded standard value in 4.8% and 16.1% patients correspondingly. The increased level of circulating immune complex was established in 20 (32.3%) patients. The concentration of ANA corresponded to standard values in all 62 (100%) patients. The evaluation of results of correlation analysis established a strong positive correlation of concentration in blood of antibodies to antigens of small and large intestines; average positive correlation of level of antibodies to antigens of small intestine and IgM, ANCA PR3, ASCA IgE, antibodies to Candida albicans classes IgM, IgG, IgE, antibodies to antigens of pancreas; average degree of positive correlation between concentration of antibodies to antigens of large intestine and IgA, IgM, circulating immune complex, ANCA PR3, DNAss, ASCA IgE, antibodies to antigens of pancreas; strong positive correlation between concentrations of IgA to Candida albicans and ANA. The detection of auto-to antibodies Saccharomyces cerevisiae, Candida albicans, ANCA, antigens of small and large intestines, pancreas and expressed degree of correlation of many indices of autoimmune reaction indicate to intensity of immune pathological process under Crohn's disease. Under Crohn's disease, the formation of antibodies to ASCA is a prognostically unfavorable sign. The immune diagnostic under Crohn's disease is necessary for evaluating severity of course of disease, differential diagnostic, establishment of prognosis and selection of individual immune correcting therapy.
本研究的目的是确定克罗恩病患儿自身免疫反应的特征。样本包括62名年龄在2至17岁之间、诊断为克罗恩病的患者。对血清中免疫球蛋白IgA、IgM、IgG、IgE、抗酿酒酵母抗体(ASCA)的IgA、IgG和IgE类、抗白色念珠菌抗体的IgA、IgM、IgG和IgE类、抗中性粒细胞胞浆抗体(ANCA)针对髓过氧化物酶(MPO)、蛋白酶3(PR3)、抗核抗体(ANA)、抗双链DNA、单链DNA抗体(抗双链和单链DNA)、抗小肠和大肠、胰腺抗原抗体、循环免疫复合物进行了评估。62例克罗恩病患者中有47例(75.8%)被诊断为高免疫球蛋白血症。29例患者(46.8%)血液中IgM水平升高。62名儿童中有19名(30.6%)被确定为高免疫球蛋白血症Y。22例患者(35.5%)检测到低免疫球蛋白血症,其中17例(77.3%)为IV型免疫球蛋白异常血症(IgA浓度单独降低)。对血清中特异性抗体发生率的评估表明,患者中最常检测到针对酿酒酵母的特异性IgE(70.9%)。22例患者(35.5%)检测到ASCA(IgA、IgG)水平升高。血液中抗双链DNA、单链DNA抗体浓度分别超过标准值的患者为4.8%和16.1%。20例患者(32.3%)循环免疫复合物水平升高。所有62例(100%)患者的ANA浓度均符合标准值。相关性分析结果评估显示,抗小肠和大肠抗原抗体血液浓度呈强正相关;抗小肠抗原抗体水平与IgM、ANCA PR3、ASCA IgE、抗白色念珠菌抗体的IgM、IgG、IgE类、抗胰腺抗原抗体呈中度正相关;抗大肠抗原抗体浓度与IgA、IgM、循环免疫复合物、ANCA PR3、单链DNA、ASCA IgE、抗胰腺抗原抗体之间呈中度正相关;抗白色念珠菌IgA与ANA浓度之间呈强正相关。检测到针对酿酒酵母、白色念珠菌、ANCA、小肠和大肠、胰腺抗原的自身抗体以及自身免疫反应许多指标的表达相关程度,表明克罗恩病免疫病理过程的强度。在克罗恩病中,ASCA抗体的形成是一个预后不良的迹象。克罗恩病的免疫诊断对于评估疾病进程的严重程度、鉴别诊断、预后判断和选择个体化免疫纠正治疗是必要的。