Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, China.
Centre for Inflammatory Bowel Disease, West China Hospital, Sichuan University, Chengdu, China.
Front Immunol. 2022 Mar 16;13:820891. doi: 10.3389/fimmu.2022.820891. eCollection 2022.
Crohn's disease (CD) is a chronic intestinal disorder characterized by refractory gastrointestinal ulcerations. Intestinal tuberculosis (ITB) is one common intestinal disease in east Asia. The two diseases share similar clinical manifestations and endoscopic characteristics. Thus, it is difficult to establish a definite diagnosis of CD, CD concomitant with ITB (CD-ITB), and ITB in practice. Some enterogeneous microbiotic markers have been applied to differentiate CD and ITB, but it remains unknown how they work for the three groups of patients. The aim of our study was to explore the diagnostic values of these enterogeneous microbiotic markers (ASCA IgG, ASCA IgA, ACCA, Anti-I2 and AMCA) among CD, CD-ITB, and ITB patients. A total of 124 individuals were retrospectively enrolled in this study, namely, 103 CD patients, 10 CD-ITB patients, 9 ITB patients, and 68 healthy controls. The demographic and clinical characteristics of these patients were collected and analyzed. The values of these individual or combined enterogeneous microbiotic markers in diagnosis and classification were assessed in CD, CD-ITB, and ITB patients. ASCA IgG, ASCA IgA, and AMCA could accurately differentiate CD patients from healthy controls with an area under curve (AUC) of 0.688, 0.601, and 0.638, respectively. ASCA IgG was significantly higher in CD patients than in CD-ITB patients (P = 0.0003). The Anti-I2 antibody was appropriate for distinguishing CD-ITB from ITB patients (P = 0.039). In CD patients, ASCA IgG was higher in severe patients than in mild (P <0.0001) and inactive patients (P <0.0001), respectively. AMCA was significantly elevated in severe and moderate patients compared to inactive patients (P = 0.001, P = 0.003, respectively). AMCA was associated with a higher risk of CD-related surgery with a significant P-value of 0.0038. In our cohort, ASCAs and AMCA could accurately distinguish CD from healthy controls with an acceptable AUC. A combination of elevated ASCA IgG and AMCA antibodies established a higher sensitivity in differentiating CD from healthy controls. Elevated ASCA IgG demonstrated a differential diagnostic value between CD and CD-ITB. Anti-I2 could also distinguish CD-ITB from ITB. The level of AMCA was associated with both disease severity and CD-related surgery. Likewise, the level of ASCA IgG was also related to disease severity.
克罗恩病（CD）是一种慢性肠道疾病，其特征为难治性胃肠道溃疡。肠结核（ITB）是东亚地区常见的一种肠道疾病。这两种疾病具有相似的临床表现和内镜特征。因此，在实践中很难明确诊断 CD、CD 合并 ITB（CD-ITB）和 ITB。一些肠源性微生物标志物已被用于区分 CD 和 ITB，但尚不清楚它们对这三组患者的作用如何。我们的研究目的是探讨这些肠源性微生物标志物（ASCA IgG、ASCA IgA、ACCA、Anti-I2 和 AMCA）在 CD、CD-ITB 和 ITB 患者中的诊断价值。共有 124 名患者被回顾性纳入本研究，包括 103 名 CD 患者、10 名 CD-ITB 患者、9 名 ITB 患者和 68 名健康对照者。收集并分析了这些患者的人口统计学和临床特征。评估了这些单独或联合肠源性微生物标志物在 CD、CD-ITB 和 ITB 患者中的诊断和分类价值。ASCA IgG、ASCA IgA 和 AMCA 可以分别以 0.688、0.601 和 0.638 的曲线下面积（AUC）准确地区分 CD 患者与健康对照者。与 CD-ITB 患者相比，CD 患者的 ASCA IgG 显著升高（P=0.0003）。Anti-I2 抗体适合区分 CD-ITB 与 ITB 患者（P=0.039）。在 CD 患者中，ASCA IgG 在重度患者中高于轻度（P<0.0001）和不活动患者（P<0.0001）。与不活动患者相比，重度和中度患者的 AMCA 显著升高（P=0.001，P=0.003）。AMCA 与 CD 相关手术的风险增加相关，其 P 值显著为 0.0038。在我们的队列中，ASCA 和 AMCA 可以以可接受的 AUC 准确地区分 CD 与健康对照者。升高的 ASCA IgG 和 AMCA 抗体联合使用可提高 CD 与健康对照者的鉴别敏感性。升高的 ASCA IgG 在 CD 与 CD-ITB 之间具有鉴别诊断价值。Anti-I2 也可区分 CD-ITB 与 ITB。AMCA 水平与疾病严重程度和 CD 相关手术有关。同样，ASCA IgG 水平也与疾病严重程度有关。
