Oudkerk Pool M, Bouma G, Meuwissen S G, von Blomberg B M, van de Merwe J P, Devillé W L, Fonk J C, Peña A S
Department of Gastroenterology, Free University Hospital, Amsterdam, The Netherlands.
J Clin Pathol. 1995 Apr;48(4):346-50. doi: 10.1136/jcp.48.4.346.
To assess prospectively the value of three serological tests for differentiating between ulcerative colitis and Crohn's disease, used either alone or combined.
Coded serum samples from 63 patients with ulcerative colitis and 67 patients with Crohn's disease were analysed. Detection assays for the presence of perinuclear antineutrophil cytoplasmic antibodies (pANCA), serum agglutinating antibodies to anaerobic coccoid rods, and specific IgG antibodies against a Kd-45/48 immunological crossreactive mycobacterial antigen complex (ImCrAC) were studied. Sensitivity, specificity, pre- and post-test probabilities, likelihood ratios, and predictive values of each of these serological tests were determined.
The sensitivity and specificity of the pANCA test for the diagnosis of ulcerative colitis were 61 and 79%, respectively. The serum agglutination test for anaerobic coccoid rods had a sensitivity of 42% and a specificity of 89% for a diagnosis of Crohn's disease. The sensitivity of specific IgG antibodies against Kd-45/48 ImCrAC in diagnosing Crohn's disease was 70% and specificity 60%. Although 100% specificity was achieved by combining all three tests in a small group of patients with Crohn's disease (n = 20), combining two or more tests had no additive clinical value. No correlation was found between the presence of any one of these antibodies and disease activity, duration, or localisation of disease. Surgery or medical treatment did not influence the presence of antibodies or the antibody titre.
The value of these tests in the differential diagnosis between ulcerative colitis and Crohn's disease is limited, but the high predictive values and specificities of different tests for both diseases suggest that these tests may be of help in studying disease heterogeneity and in defining different subgroups of patients with different pathogenesis.
前瞻性评估三种血清学检测单独或联合使用时，在鉴别溃疡性结肠炎和克罗恩病方面的价值。
对63例溃疡性结肠炎患者和67例克罗恩病患者的编码血清样本进行分析。研究针对核周抗中性粒细胞胞浆抗体（pANCA）、抗厌氧类球菌血清凝集抗体以及针对Kd - 45/48免疫交叉反应性分枝杆菌抗原复合物（ImCrAC）的特异性IgG抗体的检测方法。确定每种血清学检测的敏感性、特异性、检测前后概率、似然比和预测值。
pANCA检测对溃疡性结肠炎诊断的敏感性和特异性分别为61%和79%。抗厌氧类球菌血清凝集试验对克罗恩病诊断的敏感性为42%，特异性为89%。针对Kd - 45/48 ImCrAC的特异性IgG抗体在诊断克罗恩病时的敏感性为70%，特异性为60%。虽然在一小部分克罗恩病患者（n = 20）中联合使用这三种检测可达到100%的特异性，但联合两种或更多检测并无附加临床价值。未发现这些抗体中的任何一种与疾病活动度、病程或疾病定位之间存在相关性。手术或药物治疗不影响抗体的存在或抗体滴度。
这些检测在溃疡性结肠炎和克罗恩病鉴别诊断中的价值有限，但不同检测对两种疾病的高预测值和特异性表明，这些检测可能有助于研究疾病异质性以及定义具有不同发病机制的不同患者亚组。
