血清学抗中性粒细胞胞浆抗体在炎症性肠病中的表达及其诊断价值

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Abstract Objective By detecting the expression levels of serum perinuclear anti-neutrophil cytoplasmic antibody (p-ANCA),cytoplasmic ANCA (c-ANCA),proteinase 3 (PR3) -ANCA,myeloperoxidase (MPO) -ANCA serological autoantibodies in inflammatory bowel disease (IBD),to investigate the clinical significance of single and combined detection of four antibodies in the diagnosis and differential diagnosis of IBD.Methods A total of 123 patients with IBD diagnosed in Huizhou First People's Hospital from May 2018 to February 2021 were selected as the research objects.According to the disease type,they were divided into ulcerative colitis (UC) group (n=78) and Crohn's disease (CD) group (n=45).Fifty-six patients with non-IBD intestinal diseases were selected as the disease control group,and 30 healthy subjects were selected as the normal control group.The expression levels of p-ANCA and c-ANCA were detected by indirect immunofluorescence (IIF) method,and the expression levels of PR3-ANCA and MPO-ANCA were detected by enzyme-linked immunosorbent assay (ELISA).The difference of antibody expression in each group was compared,and the diagnostic efficacy of the four antibodies for IBD and the expression of p-ANCA in UC patients with different clinical characteristics were analyzed.Results There were significant differences in the positive rates of p-ANCA,c-A NCA,PR3-ANCA,MPO-ANCA and the combined detection of four antibodies among the four groups (P＜0.01).P-ANCA of UC group was higher than that of CD group,disease control group and normal control group,c-ANCA,PR3-ANCA and combined detection were higher than those of disease control group and normal control group,and MPO-ANCA was higher than that of disease control group,and the differences were statistically significant (P＜0.008).The c-ANCA and combined detection in CD group were higher than those in disease control group and normal control group,and MPO-ANCA was higher than that in disease control group,and the differences were statistically significant (P＜0.008).The sensitivity and accuracy of the combined detection of four antibodies in the diagnosis of IBD were the highest,which were 66.7% and 75.1%,respectively.PR3-ANCA and MPO-ANCA had the highest specificity (95.3%).The positive predictive values of p-ANCA,c-ANCA,PR3-ANCA and MPO-ANCA were 91.2%,89.9%,87.9%,88.9% and 88.2%,respectively.The negative predictive values were 53.3%,60.0%,46.6%,47.4% and 64.7%,respectively.PR3-ANCA has the highest specificity in the diagnosis of UC,but the sensitivity is only 26.9%.p-ANCA has a good diagnostic efficiency in the diagnosis of UC,and combined detection can improve the sensitivity of UC,but the specificity is decreased.C-ANCA has a low sensitivity and specificity in the diagnosis of CD,and the differential diagnostic efficiency is low.The positive rate of p-ANCA in patients with moderate to severe UC was higher than that in patients with mild UC,and the proportion of patients with lesions in extensive colon was higher than that in other parts,and the differences were statistically significant (P＜0.05).Conclusion PR3-ANCA,p-ANCA,c-ANCA and MPO-ANCA have certain auxiliary value in the diagnosis and differential diagnosis of IBD,and the combined detection is more valuable than the single detection.p-ANCA may be beneficial to the differential diagnosis of UC and CD.The expression of p-ANCA is related to the severity and lesion location of UC,and has a potential auxiliary role in the evaluation of UC,which is worthy of further study.

Key words： Ulcerative colitis Crohn's disease Serological markers Anti-neutrophil cytoplasmic antibody

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