Bansi D S, Fleming K A, Chapman R W
Department of Gastroenterology, University of Oxford, Oxford Radcliffe Hospital, Headington, UK.
Gut. 1996 Mar;38(3):384-9. doi: 10.1136/gut.38.3.384.
Antineutrophil cytoplasmic antibodies (ANCA) have been reported in up to 87% of patients with primary sclerosing cholangitis with or without ulcerative colitis (PSC +/- UC) and in 68% of those with UC only. Compared with other liver and diarrhoeal diseases, ANCA have high specificity for PSC (+/- UC) and UC only. This study aimed to determine the prevalence and significance of ANCA in these two diseases and whether the ANCA titre or IgG subclass, or both, could distinguish between PSC + UC and UC only. Subjects included 63 patients with PSC, 85 with UC, 17 with coeliac disease, and 10 with dermatitis herpeteformis and 36 normal subjects. ANCA was detected using the immunoalkaline phosphatase method. The IgG subclass of ANCA was determined in 27 PSC + UC and 30 UC only patients using a panel of mouse monoclonal antibodies specific for the IgG subclasses. At a serum dilution of 1:5, ANCA had a diagnostic sensitivity of 65% for all PSC and 45% for UC only. For PSC + UC the sensitivity was 70% at 1:5 (p = 0.004 v UC only). At 1:50, the sensitivity values were 54% and 25% respectively for PSC + UC and UC only (p = 0.0006). In PSC, ANCA positivity was significantly associated with extensive involvement of the biliary tree but not with other clinical parameters. In UC only, the median disease duration was significantly greater in ANCA positive patients. The PSC + UC ANCA showed increased IgG3 compared with UC only ANCA (p < 0.05), together with increased IgG2 and IgG4 (p = NS). ANCA is a diagnostic marker in PSC and UC. While the higher titres and different IgG subclass distribution of ANCA in PSC + UC patients compared with those with UC only may reflect differences in underlying immune regulation, determination of the ANCA titre and IgG subclass is unlikely to have a role in distinguishing between PSC + UC and UC only ANCA. Future identification of the antigen(s) for ANCA should allow the development of a more sensitive and specific test for the diagnosis of these two conditions and also determine if ANCA is associated with UC or PSC.
据报道，在原发性硬化性胆管炎伴或不伴溃疡性结肠炎（PSC±UC）的患者中，高达87%可检测到抗中性粒细胞胞浆抗体（ANCA），而仅患溃疡性结肠炎（UC）的患者中这一比例为68%。与其他肝脏疾病和腹泻性疾病相比，ANCA对PSC（±UC）和仅患UC具有较高的特异性。本研究旨在确定这两种疾病中ANCA的患病率和意义，以及ANCA滴度或IgG亚类，或两者是否能区分PSC+UC和仅患UC。研究对象包括63例PSC患者、85例UC患者、17例乳糜泻患者、10例疱疹样皮炎患者和36名正常受试者。采用免疫碱性磷酸酶法检测ANCA。使用一组针对IgG亚类的小鼠单克隆抗体，对27例PSC+UC患者和30例仅患UC的患者测定ANCA的IgG亚类。在血清稀释度为1:5时，ANCA对所有PSC患者的诊断敏感性为65%，对仅患UC的患者为45%。对于PSC+UC患者，在1:5稀释度时敏感性为70%（与仅患UC患者相比，p=0.004）。在1:50稀释度时，PSC+UC患者和仅患UC患者的敏感性值分别为54%和25%（p=0.0006）。在PSC患者中，ANCA阳性与胆管树广泛受累显著相关，但与其他临床参数无关。在仅患UC的患者中，ANCA阳性患者的疾病中位病程显著更长。与仅患UC患者的ANCA相比，PSC+UC患者的ANCA显示IgG3增加（p<0.05），同时IgG2和IgG4也增加（p=无显著性差异）。ANCA是PSC和UC的诊断标志物。虽然与仅患UC的患者相比，PSC+UC患者的ANCA滴度更高且IgG亚类分布不同，这可能反映了潜在免疫调节的差异，但测定ANCA滴度和IgG亚类不太可能在区分PSC+UC和仅患UC的ANCA方面发挥作用。未来鉴定ANCA的抗原应有助于开发一种更敏感、特异的检测方法来诊断这两种疾病，并确定ANCA是否与UC或PSC相关。
