Faculdade de Medicina da Universidade de São Paulo, Hospital das Clínicas, Departamento de Gastroenterologia, São Paulo, SP, Brasil.
Faculdade de Medicina da Universidade de São Paulo, Hospital das Clínicas, Laboratório de Investigação Médica Reumatologia, São Paulo, SP, Brasil.
Arq Gastroenterol. 2021 Oct-Dec;58(4):495-503. doi: 10.1590/S0004-2803.202100000-89.
Perinuclear anti-neutrophil cytoplasmic antibodies (p-ANCA) and anti-Saccharomyces cerevisiae antibodies (ASCAs) have long been used to differentiate between Crohn's disease (CD) and ulcerative colitis (UC), more recently having been used as prognostic indicators.
To determine the diagnostic accuracy of serological markers in the identification of pediatric CD and UC in Sao Paulo, Brazil, as well as to correlate those markers with characteristics demographic and clinical of these two diseases.
Retrospective cross-sectional multi-center study involving pediatric patients with inflammatory bowel disease (IBD). We identified ASCAs serological markers and p-ANCA, correlating their presence with demographic and clinical data, not only in the patients with IBD but also in a group of age-matched gastrointestinal disease-free controls.
A total of 122 patients, 74 with IBD (46% males), treated at four pediatric gastroenterology referral centers, the mean age of 13±7 years, 49 (66%) with CD, and 25 (34%) with UC. The control Group comprised 48 patients (54% males). The proportion of patients testing positive for p-ANCA was significantly higher in the UC group (69.9%) compared to the CD group (30.4%), as well as being significantly higher in the CD group versus the control Group (P<0.001 for both). The proportion of patients testing positive for ASCA IgA (76.2%) and ASCA IgG (94.4%) markers was also significantly higher in the CD group than in the control Group (P<0.001), and such positivity correlated significantly with the use of immunomodulatory medications such as azathioprine and anti-tumor necrosis factor agents (azathioprine 38.9%, anti-TNF 55.6%; P=0.002). In the CD group, the proportion of patients testing positive for the ASCA IgA was significantly higher among those who underwent surgery than among those who did not (26.86±17.99; P=0.032).
In pediatric patients with IBD in Sao Paulo, Brazil, serological tests proving to be highly specific, although not very sensitive, for the diagnosis of IBD. However, the serological markers showed a positive correlation with the severity of the disease.
核周抗中性粒细胞胞浆抗体 (p-ANCA) 和抗酿酒酵母抗体 (ASCA) 一直被用于区分克罗恩病 (CD) 和溃疡性结肠炎 (UC)，最近也被用作预后指标。
在巴西圣保罗确定血清标志物在识别儿科 CD 和 UC 中的诊断准确性，并将这些标志物与这两种疾病的特征性人口统计学和临床特征相关联。
回顾性多中心研究涉及患有炎症性肠病 (IBD) 的儿科患者。我们确定了 ASCA 血清标志物和 p-ANCA，并将其存在与人口统计学和临床数据相关联，不仅在 IBD 患者中，而且在一组年龄匹配的无胃肠道疾病对照者中也是如此。
共有 122 名患者（46%为男性）接受了四家儿科胃肠病学转诊中心的治疗，平均年龄为 13±7 岁，其中 49 名（66%）为 CD，25 名（34%）为 UC。对照组由 48 名患者（54%为男性）组成。UC 组 p-ANCA 阳性率（69.9%）明显高于 CD 组（30.4%），而 CD 组也明显高于对照组（两者均 P<0.001）。CD 组 ASCA IgA（76.2%）和 ASCA IgG（94.4%）标志物阳性率也明显高于对照组（P<0.001），并且这种阳性与免疫调节剂药物的使用如硫唑嘌呤和抗肿瘤坏死因子药物显著相关（硫唑嘌呤 38.9%，抗 TNF 55.6%；P=0.002）。在 CD 组中，接受手术的患者 ASCA IgA 阳性率明显高于未接受手术的患者（26.86±17.99；P=0.032）。
在巴西圣保罗的儿科 IBD 患者中，血清学检查被证明对 IBD 的诊断具有高度特异性，尽管敏感性不高。然而，血清标志物与疾病的严重程度呈正相关。
