García-Herola A, Nos P, Hoyos M, Hinojosa J, Molés J R, Pascual S, Bustamante M, Sánchez Cuenca J M, Carmona E, Ponce J, Berenguer J
Servicio de Medicina Digestiva, Hospital La Fe, Valencia.
Gastroenterol Hepatol. 1998 Apr;21(4):169-73.
We have studied prospectively 126 consecutive patients recruited with a known diagnosis of ulcerative colitis (UC; n = 78) and Crohn's disease (CD; n = 48) for anti-neutrophil cytoplasmatic antibodies (ANCA) by indirect immunofluorescence (IFI). Forty-six percent of UC and 18% of CD patients were found positive. The sensitivity and specificity for UC diagnosis were 0.46 and 0.81, respectively. We evaluated the pattern of IFI exhibited (perinuclear: pANCA and cytoplasmatic: cANCA). cANCA was found in 77% of CD and in only 30% of UC patients (p = 0.01). Sera from all CD patients were positive at a 1:20 dilution (and not at higher dilution) and it occurred in only in 14 UC patients (30%). Positive sera were also tested to characterize the antigen specificity by enzyme-linked immunosorbent assay (ELISA) but the antigenic nature of ANCA could not be identified in most cases. No differences were found between ANCA positive and ANCA negative patients regarding colonic extension (UC) or colonic involvement (CD), activity and colectomy. We conclude that ANCA may be a helpful diagnostic test in UC patients but it not seems to be important as a marker of activity. ANCA positivity can reflect disease heterogeneity in UC patients, perhaps discriminating those with immunologic disturbances.
我们对126例连续招募的已知诊断为溃疡性结肠炎（UC；n = 78）和克罗恩病（CD；n = 48）的患者进行了前瞻性研究，通过间接免疫荧光法（IFI）检测抗中性粒细胞胞浆抗体（ANCA）。发现46%的UC患者和18%的CD患者呈阳性。UC诊断的敏感性和特异性分别为0.46和0.81。我们评估了所表现出的IFI模式（核周型：pANCA和胞浆型：cANCA）。发现77%的CD患者和仅30%的UC患者存在cANCA（p = 0.01）。所有CD患者的血清在1:20稀释度时呈阳性（更高稀释度时则不然），而仅14例UC患者（30%）出现这种情况。还通过酶联免疫吸附测定（ELISA）对阳性血清进行检测以确定抗原特异性，但在大多数情况下无法识别ANCA的抗原性质。在结肠病变范围（UC）或结肠受累情况（CD）、疾病活动度和结肠切除术方面，ANCA阳性和阴性患者之间未发现差异。我们得出结论，ANCA可能是UC患者的一项有用诊断检测，但似乎并非疾病活动度的重要标志物。ANCA阳性可反映UC患者的疾病异质性，或许能区分出存在免疫紊乱的患者。
