Department of Immunology, Canberra Hospital, ACT, Australia; Department of Immunopathology and Infectious Immunoassay, ACT Pathology, ACT, Australia.
Gastroenterology and Hepatology Unit, Canberra Hospital, ACT, Australia; Australian National University Medical School, Australian National University, ACT, Australia.
Pathology. 2019 Oct;51(6):634-639. doi: 10.1016/j.pathol.2019.07.002. Epub 2019 Aug 26.
Traditionally anti-neutrophil cytoplasmic antibodies (ANCA) are used to subtype patients with inflammatory bowel disease (IBD) and to predict primary sclerosing cholangitis (PSC). The clinical utility of this testing in the Australian context is not known. Our retrospective, cross-sectional study looked at the results of ANCA testing performed during routine clinical review and aimed to retrospectively review (1) the distribution of different ANCA subtypes for IBD patients, (2) the temporal change of ANCA status, and (3) the predictive value of ANCA for PSC. Sixty-four IBD patients attending our hospital gastroenterology clinic between 2012 and 2016 had at least one ANCA test requested. Surprisingly, >80% of the IBD patients in our cohort who underwent ANCA testing had a positive ANCA result and a significant proportion had positive PR3 antibodies. However, no specific ANCA pattern predicted a specific IBD subtype or clinical course. Pairing ANCA and anti-Saccharomyces cerevisiae (ASCA) did not add value in subtyping IBD for these patients. Our study suggests that there is little value in ordering an ANCA for patients with IBD.
传统上，抗中性粒细胞胞浆抗体（ANCA）用于对炎症性肠病（IBD）患者进行亚型分类，并预测原发性硬化性胆管炎（PSC）。这种检测在澳大利亚环境中的临床实用性尚不清楚。我们的回顾性、横断面研究观察了在常规临床检查中进行的 ANCA 检测结果，旨在回顾性分析：（1）IBD 患者的不同 ANCA 亚型分布；（2）ANCA 状态的时间变化；（3）ANCA 对 PSC 的预测价值。2012 年至 2016 年间，我们医院的胃肠病学诊所共收治了 64 名 IBD 患者，其中至少有一名患者要求进行 ANCA 检测。令人惊讶的是，我们队列中接受 ANCA 检测的超过 80%的 IBD 患者 ANCA 检测结果呈阳性，且相当一部分患者的 PR3 抗体呈阳性。然而，没有特定的 ANCA 模式可以预测特定的 IBD 亚型或临床过程。对于这些患者，将 ANCA 与抗酿酒酵母抗体（ASCA）联合检测并不能提高 IBD 亚型分类的价值。我们的研究表明，对于 IBD 患者，进行 ANCA 检测的价值不大。
