不典型抗中性粒细胞胞质抗体对溃疡性结肠炎活动度的评估价值

doi:10.3969/j.issn.1673-8640.2019.09.011

摘要/Abstract

摘要：

目的探讨不典型抗中性粒细胞胞质抗体（aANCA）在溃疡性结肠炎（UC）活动度评估及病情监测中的价值。方法选取UC患者103例,其中缓解期37例、活动期66例（轻度7例、中度45例、重度14例）,以其他肠道疾病（急性感染性肠炎、肠息肉、肠结核、肠易激综合征等）患者64例作为疾病对照组,以体检健康者40名作为正常对照组。采用酶联免疫吸附试验（ELISA）定量检测血清aANCA水平,同时检测红细胞沉降率（ESR）、C反应蛋白（CRP）、血红蛋白（Hb）、红细胞平均体积（MCV）、红细胞分布宽度（RDW）、血小板（PLT）计数、白蛋白（Alb）。采用Spearman相关分析评估各项目与内镜Baron分级的相关性。采用受试者工作特征（ROC）曲线评价各指标对活动性UC的诊断效能。结果 UC活动期组aANCA、ESR均明显高于UC缓解期组（P<0.05）,Hb明显低于UC缓解期组（P<0.05）,2个组之间MCV、RDW、PLT计数、CRP和Alb差异均无统计学意义（P>0.05）。UC缓解期组aANCA明显高于疾病对照组和正常对照组（P<0.05）,其他指标3组之间差异均无统计学意义（P>0.05）。UC患者中轻、中、重度活动者aANCA水平依次升高（P<0.05）。aANCA与Baron评分呈正相关（r_s=0.694,P<0.001）,而ESR、Hb与Baron评分无相关性（r_s值分别为0.303、0.155,P>0.05）。ROC曲线分析结果显示,aANCA诊断活动性UC的曲线下面积（AUC）为0.895,最佳临界值为6.27 IU/mL,敏感性和特异性分别为71.7%和93.3%。结论 aANCA可用于UC疾病活动度的评估,且与内镜Baron分级有关。

关键词: 抗中性粒细胞胞质抗体, 不典型抗中性粒细胞胞质抗体, 溃疡性结肠炎, 红细胞沉降率, 血红蛋白

Abstract:

Objective To investigate the role of atypical anti-neutrophil cytoplasmic antibodies（aANCA） in the activity evaluation and disease monitoring of ulcerative colitis（UC）. Methods A total of 103 UC patients,64 non-UC patients（acute enteritis,intestinal polyps,intestinal tuberculosis and irritable bowel syndrome） and 40 healthy subjects were enrolled. Among the 103 UC patients,37 cases were in remission phase,and 66 cases were in active phase（7 cases of mild,45 cases of moderate and 14 cases of severe）. Serum level of aANCA was determined by enzyme-linked immunosorbent assay（ELISA）. Erythrocyte sedimentation rate（ESR）,C-reactive protein（CRP）,platelet（PLT） count,hemoglobin（Hb）,mean corpuscular volume（MCV）,red blood cell distribution width（RDW） and albumin（Alb） were determined. The correlation between these parameters and Baron endoscopic score was analyzed by Spearman analysis. Receiver operating characteristic（ROC） curve was used to evaluate the diagnostic efficacy of UC activity. Results The serum levels of aANCA and ESR in UC patients in active phase were higher than those in remission phase,while the serum level of Hb in active UC group was lower than that in remission UC group（P<0.05）. There was no statistical significance between active and remission UC groups in MCV,RDW,PLT count,CRP and Alb（P>0.05）. In remission UC group,aANCA level was higher than those in non-UC group and healthy control group（P<0.05）,but there was no statistical significance in the serum levels of the other indicators among the 3 groups（P>0.05）. In active UC group,the levels of aANCA were in an order of severe>moderate>mild patients（P<0.05）. A positive correlation was demonstrated between serum aANCA level and Baron endoscopic score（r_s=0.649,P<0.001）,but there was no correlation of ESR and Hb level with Baron endoscopic score（r_s=0.303 and 0.155,P>0.05）. The area under ROC curve（AUC） of aANCA was 0.895 for the diagnosis of active UC. The specificity of aANCA was 93.3%,the sensitivity was 71.7%,and the optimal cut-off value was 6.27 IU/mL. Conclusions The aANCA may be used as a useful indicator in the evaluation of UC disease activity,and it is correlated with Baron endoscopic score.

Key words: Anti-neutrophil cytoplasmic antibody, Atypical anti-neutrophil cytoplasmic antibody, Ulcerative colitis, Erythrocyte sedimentation rate, Hemoglobin

中图分类号:

R446.1

曾俊祥, 黄忆磊, 葛文松, 潘秀军, 沈立松. 不典型抗中性粒细胞胞质抗体对溃疡性结肠炎活动度的评估价值[J]. 检验医学, 2019, 34(9): 815-820.

ZENG Junxiang, HUANG Yilei, GE Wensong, PAN Xiujun, SHEN Lisong. Role of aANCA in the evaluation of ulcerative colitis[J]. Laboratory Medicine, 2019, 34(9): 815-820.

图/表 5

参考文献 23

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项目	例数	aANCA（IU/mL）	Hb（g/L）	MCV（fL）	RDW
UC缓解期组	37	4.4（3.2~17.6）^*#	132.4±25.4	87.2±6.5	14.9±2.5
UC活动期组	66	13.1（5.5~24.6）^*#△	111.0±20.1^*#△	86.4±8.3^*#	14.5±2.5^*#
疾病对照组	64	1.3（0.8~1.8）	130.1±19.1	90.4±5.2	13.9±2.1
正常对照组	40	0.1（0.1~0.8）	139.6±17.6	89.2±5.7	14.2±2.0
统计值		85.44	20.42	5.95	3.06
P值		<0.01	<0.01	<0.01	0.03
项目	ESR（mm/h）		Alb（g/L）	CRP（mg/L）	PLT计数（×10⁹/L）
UC缓解期组	18.5（9.0~27.8）		42.0±6.6	8.0（8.0~8.0）	233.5±96.8
UC活动期组	24.0（13.0~36.0）^*#△		39.3±3.1^*#	10.0（8.0~18.5）^*#	252.0±93.0
疾病对照组	8.5（6.0~10.0）		41.6±4.7	8.0（8.0~8.0）	230.2±70.0
正常对照组	7.0（5.3~9.0）		42.8±5.5	8.0（8.0~8.0）	263.5±70.1
统计值	60.62		3.02	22.62	1.30
P值	<0.01		0.03	0.01	0.16

项目	例数	aANCA（IU/mL）	Hb（g/L）	MCV（fL）	RDW
UC缓解期组	37	4.4（3.2~17.6）^*#	132.4±25.4	87.2±6.5	14.9±2.5
UC活动期组	66	13.1（5.5~24.6）^*#△	111.0±20.1^*#△	86.4±8.3^*#	14.5±2.5^*#
疾病对照组	64	1.3（0.8~1.8）	130.1±19.1	90.4±5.2	13.9±2.1
正常对照组	40	0.1（0.1~0.8）	139.6±17.6	89.2±5.7	14.2±2.0
统计值		85.44	20.42	5.95	3.06
P值		<0.01	<0.01	<0.01	0.03
项目	ESR（mm/h）		Alb（g/L）	CRP（mg/L）	PLT计数（×10⁹/L）
UC缓解期组	18.5（9.0~27.8）		42.0±6.6	8.0（8.0~8.0）	233.5±96.8
UC活动期组	24.0（13.0~36.0）^*#△		39.3±3.1^*#	10.0（8.0~18.5）^*#	252.0±93.0
疾病对照组	8.5（6.0~10.0）		41.6±4.7	8.0（8.0~8.0）	230.2±70.0
正常对照组	7.0（5.3~9.0）		42.8±5.5	8.0（8.0~8.0）	263.5±70.1
统计值	60.62		3.02	22.62	1.30
P值	<0.01		0.03	0.01	0.16

UC活动度	例数	aANCA（IU/mL）	ESR（mm/h）	Hb（g/L）
轻度	7	4.26（2.62~4.26）	14.00（8.00~28.0）	120.12±19.20
中度	45	16.37（10.38~32.18）^*	27.50（16.75~37.75）^*	109.48±16.81^*
重度	14	31.05（22.40~52.75）^*#	33.50（14.25~69.00）^*	99.14±23.79 ^*

UC活动度	例数	aANCA（IU/mL）	ESR（mm/h）	Hb（g/L）
轻度	7	4.26（2.62~4.26）	14.00（8.00~28.0）	120.12±19.20
中度	45	16.37（10.38~32.18）^*	27.50（16.75~37.75）^*	109.48±16.81^*
重度	14	31.05（22.40~52.75）^*#	33.50（14.25~69.00）^*	99.14±23.79 ^*

指标	AUC（95%CI）	最佳临界值	敏感性（%）	特异性（%）	Yonden指数
aANCA	0.895（0.832~0.940）	6.27 IU/mL	71.7	93.3	0.704
ESR	0.839（0.768~0.895）	11 mm/h	88.0	81.7	0.696
Hb	0.768（0.690~0.834）	122 g/L	75.9	75.0	0.509