| Objective To investigate the clinical significance of serumal perinuclear antineutrophil cytoplasmic antibody(p-ANCA), anti-saccharomyces cerevisiae antibody(ASCA), anti-intestinal goblet cell antibody(GAB) and anti-pancreatic antibody(PAB) in diagnosis and differential diagnosis of inflammatory bowel disease(IBD), and whether they are associated with IBD clinical phenotype.Methods The patients with IBD or non-IBD intestinal disease met the study criteria were included in this study from October 2014 to April 2015 in First Affiliated Hospital of Fujian Medical University. The clinical datas were collected and the serumal ASCA-Ig A, ASCA-Ig G, p-ANCA, GAB and PAB were tested by indirect immunofluorescence assay(IIFA). And then the significance of serumal anto-antibodies and their correlation with IBD’s clinical phenotype were analysised respectively.Results Of 127 patients included, 32 were UC patients(M/F=19/13, with average age of 44.0±15.8 years old), 47 CD patients(M/F=30/17, 30.6±13.4), 48 non-IBD patients as controls(M/F=28/20, 45.6±16.0). 1.The positive rates of p-ANCA in patients with UC, CD, IBD, control group were 37.5%, 4.3%, 17.7% and 2.1%, respectively. The presence in IBD patients was higher than in control group(p=0.008), and it was higher in UC than in CD group(p<0.001). The presence of PAB in UC, CD, IBD, control group were 9.4%, 70.2%, 45.6% and 6.3%, respectively. It was higher in IBD than in control group(p<0.001), and also higher in CD than in UC group(p<0.001). 2.Of 12 UC patients with positive p-ANCA, 91.7% were negative PAB. And 33 CD patients with positive PAB, 97.0% are negative p-ANCA. The combination of a positive p-ANCA and a negative PAB(p-ANCA+/PAB-) yielded a sensitivity, specificity, positive and negative predictive value of 34.4%, 97.9%, 91.7% and 68.7%,respectively for the diagnosis of UC. The p-ANCA-/PAB+ had a sensitivity, specificity, positive and negative predictive value of 68.1%, 93.8%, 94.1% and 66.7%, respectively for diagnosis of CD. The specificity of ASCA alone to diagnose IBD was 97.9%, and the positive predictive value was 92.3%. The specificity and positive predictive value of ASCA-Ig G alone in the diagnose of IBD were both at a high level of 100.0%. 3. The positive percentage of p-ANCA in CD patients with >40 age at diagnosis was higher than that in ≤40(25.0% vs 0.0%, P=0.026). The percentages of ASCA positivity were different among CD patients with internal penetrating(60.0%), with structuring(20.0%), and with non-penetrating non-stricturing behavior(9.1%, p=0.042). The positive-GAB rate in female CD patients was higher than in male(76.5% vs 40.0%, p=0.016). There was no statistically significant association between p-ANCA or GAB and clinical feature in patients with UC, as well as PAB in CD patients.Conclusions 1. Positive ASCA, ASCA-Ig G are both useful for diagnosis of IBD. The combination of p-ANCA and PAB is useful for differenting UC and CD, p-ANCA positive/PAB negative suggests the diagnosis of UC, and p-ANCA negative/PAB positive suggests the diagnosis of CD. 2. The positive p-ANCA rate was relatively higher in senior patients. The percentage of positive-ASCA was higher in CD with internal stricturing or with penetrating behavior, as well as GAB in female CD patients. Expression of p-ANCA and GAB was not associated with UC clinical phenotype. |
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