Hertervig E, Wieslander J, Johansson C, Wiik A, Nilsson A
Dept. of Medicine, University Hospital, Lund, Sweden.
Scand J Gastroenterol. 1995 Jul;30(7):693-8. doi: 10.3109/00365529509096315.
Anti-neutrophil cytoplasmic antibodies (ANCA), originally found to be associated with vasculitis, have been reported to be present in chronic inflammatory bowel disease. Most often the ANCA staining pattern is of the perinuclear type (p-ANCA), although nuclear and cytoplasmic stainings are seen. Single studies have shown some of the antibodies to react with lactoferrin or cathepsin G; however, most studies have not been able to determine a main antigenic specificity. We studied the prevalence of ANCA in sera from 155 patients with ulcerative colitis, 128 patients with Crohn's disease, and 51 patients with coeliac disease. The presence of ANCA was correlated to disease activity, extent, and age of onset of the diseases. Furthermore, we tried to characterize the antigen specificity by enzyme-linked immunosorbent assay (ELISA), using elastase, lactoferrin, myeloperoxidase, proteinase 3, and cathepsin G as antigens.
The sera were screened for ANCA by indirect immunofluorescence. Anti-nuclear antibodies (ANA) were analysed on HEp2 cells, and ELISA for specific ANCA was performed using the antigens mentioned.
Most of the sera with positive immunofluorescence had the p-ANCA type of pattern. Seventy-eight of 155 (50.3%) of the patients with ulcerative colitis were ANCA-positive, compared with 31 of 128 (24.2%) of patients with Crohn's disease (p < 0.001). However, in the subgroup with Crohn's colitis, 16 of 44 (36.4%) were ANCA-positive. Only 4 of 51 patients (7.7%) with coeliac disease showed positive immunofluorescence (p < 0.001 compared with ulcerative colitis). Less than 10% of the samples were positive in the specific ELISA assays; thus other than the most well known granule proteins can be the target for ANCA in ulcerative colitis.
ANCA occur significantly more often in ulcerative colitis than in Crohn's disease. However, the prevalence of ANCA is rather high in Crohn's colitis. ANCA are thus of limited value in differentiating Crohn's colitis from ulcerative colitis. ANCA found in inflammatory bowel disease are different from those associated with vasculitis. The antigen(s) responsible remain to be determined.
抗中性粒细胞胞浆抗体（ANCA）最初被发现与血管炎相关，据报道在慢性炎症性肠病中也存在。ANCA染色模式最常见的是核周型（p-ANCA），不过也可见核型和胞浆型染色。个别研究显示部分抗体可与乳铁蛋白或组织蛋白酶G发生反应；然而，大多数研究未能确定主要的抗原特异性。我们研究了155例溃疡性结肠炎患者、128例克罗恩病患者和51例乳糜泻患者血清中ANCA的患病率。ANCA的存在与疾病活动度、范围及发病年龄相关。此外，我们尝试通过酶联免疫吸附测定（ELISA），以弹性蛋白酶、乳铁蛋白、髓过氧化物酶、蛋白酶3和组织蛋白酶G作为抗原，来鉴定抗原特异性。
通过间接免疫荧光法筛查血清中的ANCA。在人喉表皮样癌细胞（HEp2细胞）上分析抗核抗体（ANA），并使用上述抗原进行特异性ANCA的ELISA检测。
大多数免疫荧光阳性的血清呈现p-ANCA型模式。155例溃疡性结肠炎患者中有78例（50.3%）ANCA阳性，而128例克罗恩病患者中有31例（24.2%）ANCA阳性（p<0.001）。然而，在克罗恩病结肠炎亚组中，44例中有16例（36.4%）ANCA阳性。51例乳糜泻患者中只有4例（7.7%）显示免疫荧光阳性（与溃疡性结肠炎相比，p<0.001）。在特异性ELISA检测中，不到10%的样本呈阳性；因此，除了最知名的颗粒蛋白外，其他蛋白也可能是溃疡性结肠炎中ANCA的靶标。
ANCA在溃疡性结肠炎中的出现频率显著高于克罗恩病。然而，ANCA在克罗恩病结肠炎中的患病率相当高。因此，ANCA在区分克罗恩病结肠炎和溃疡性结肠炎方面价值有限。在炎症性肠病中发现的ANCA与血管炎相关的ANCA不同。其相关抗原仍有待确定。
