抗中性粒细胞胞浆抗体在炎症性肠病中的患病率及诊断作用

Prevalence and diagnostic role of antineutrophil cytoplasmic antibodies in inflammatory bowel disease.

作者信息

Bansi D S, Chapman R W, Fleming K A

机构信息

Department of Gastroenterology, Oxford Radcliffe Hospital, UK.

出版信息

Eur J Gastroenterol Hepatol. 1996 Sep;8(9):881-5.

PMID:8889455

Abstract

BACKGROUND

Antineutrophil cytoplasmic antibodies (ANCA) are of proven diagnostic value in a variety of vasculitides, where they are also thought to play a pathogenic role. ANCA has also been detected in the serum of patients with idiopathic inflammatory bowel disease (IBD), both ulcerative colitis (UC) and Crohn's disease (CD), and primary sclerosing cholangitis (PSC) with or without concomitant IBD. Although the prevalence in PSC and UC is reported to be up to 85%, a much lower prevalence of around 10-20% has been reported in CD.

AIM

To determine ANCA prevalence in a group of British patients with IBD and evaluate their use as a serological marker to distinguish between UC and CD.

METHODS

A total of 99 UC-only patients (44 males, median age 50) and 41 CD patients (11 males, median age 47) were tested for ANCA using an alkaline phosphatase technique at a 1:5 serum dilution. Controls were other diarrhoeal diseases including 17 coeliac disease (4 males, median age 41), 23 irritable bowel syndrome (5 males, median age 42), 5 infectious colitis (2 male, median age 64) and 36 healthy volunteers (13 males, median age 43).

RESULTS

ANCA was detected in 42/99 (42.4%) UC patients but in only 2/41 (5%) CD (P < 0.0001). All ANCA were perinuclear in distribution. No ANCA was detected in the control sera. The sensitivity of the test for the diagnosis of UC was 42% with a specificity of 98%. In patients with UC, no association was found between presence of ANCA and age, sex, disease extent, treatment or activity. However, ANCA-positive UC patients had longer median duration of disease (50 months vs. 29 months, P = 0.037). Both CD ANCA-positive patients had colonic involvement, but one also had ileal disease. Both had inactive disease and one was on mesalazine.

CONCLUSIONS

ANCA is highly specific for UC and may be a helpful diagnostic test in distinguishing UC from CD and other diarrhoeal illnesses. Although ANCA positivity may reflect disease heterogeneity within UC, no association with clinical features or treatment of UC was demonstrated and it is therefore unlikely to play a pathogenic role. The correlation with disease duration needs further investigation.

摘要

背景

抗中性粒细胞胞浆抗体（ANCA）在多种血管炎中已被证实具有诊断价值，人们还认为它们在这些疾病中发挥致病作用。在特发性炎症性肠病（IBD）患者血清中也检测到了ANCA，包括溃疡性结肠炎（UC）和克罗恩病（CD），以及合并或不合并IBD的原发性硬化性胆管炎（PSC）。虽然据报道PSC和UC中的患病率高达85%，但CD中的患病率要低得多，约为10%-20%。

目的

确定一组英国IBD患者中ANCA的患病率，并评估其作为区分UC和CD的血清学标志物的用途。

方法

使用碱性磷酸酶技术，以1:5的血清稀释度对99例仅患UC的患者（44例男性，中位年龄50岁）和41例CD患者（11例男性，中位年龄47岁）进行ANCA检测。对照组为其他腹泻性疾病，包括17例乳糜泻（4例男性，中位年龄41岁）、23例肠易激综合征（5例男性，中位年龄42岁）、5例感染性结肠炎（2例男性，中位年龄64岁）和36名健康志愿者（13例男性，中位年龄43岁）。

结果

99例UC患者中有42例（42.4%）检测到ANCA，但41例CD患者中仅2例（5%）检测到（P<0.0001）。所有ANCA均呈核周分布。对照血清中未检测到ANCA。该检测对UC诊断的敏感性为42%，特异性为98%。在UC患者中，未发现ANCA的存在与年龄、性别、疾病范围、治疗或活动之间存在关联。然而，ANCA阳性的UC患者疾病中位持续时间更长（50个月对29个月，P=0.037）。两名CD患者ANCA阳性均有结肠受累，但其中一名也有回肠疾病。两人疾病均不活动，其中一人正在服用美沙拉嗪。