方法 选择IBD患儿22例,其中溃疡性结肠炎(UC) 6例,克罗恩病(CD)16例;非IBD儿童24例。用间接荧光法测定血清核周型抗中性粒细胞胞浆抗体(pANCA),酶联免 疫法测定抗酿酒酵母抗体(ASCA)IgG和IgA、抗乙糖苷甘露糖抗体(AMCA)IgG、抗乙糖苷壳糖抗体(ACCA)IgA、抗细菌鞭毛蛋 白抗体cBir1-IgG(Anti-cBir1-IgG)和粪钙卫蛋白(FC)水平。 结果 UC患儿血pANCA抗体均阳性(100.0%),而CD患儿和非IBD 儿童均阴性,三组间差异有统计学意义(P < 0.01)。CD患儿血ASCA IgA和抗cBir1-IgG阳性率均为62.5%,血ASCA IgG阳性率为 50.0%,血ACCA IgA和AMCA IgG阳性率均为37.5%;而UC患儿和非IBD儿童上述抗体均阴性,差异有统计学意义(P均 < 0.01)。 IBD患儿FC阳性率为100.0%,高于非IBD儿童的54.2%,差异有统计学意义(P < 0.001)。 结论 血pANCA是诊断UC的特异性指 标。血ACCA IgA、AMCA IgG、ASCA IgG和IgA、抗cBir1-IgG对CD的诊断有一定特异性。FC增高可反映IBD病情的活动性,但不能 作为IBD与非IBD鉴别诊断的依据。
Objective To investigate the biological markers and their clinical significance in diagnosis and differential diagnosis of inflammatory bowel disease (IBD) in children. Methods The study had 22 cases of IBD including 6 cases of ulcerative colitis (UC) and 16 cases of Crohn’s Disease (CD). Twenty-four children without IBD were selected as controls. The serum perinuclear anti-neutrophil cytoplasmic antibody (pNACA) was measured by indirect immune fluorescence method. The serum anti-saccharomyces cerevisiae antibody (ASCA) IgG and IgA, anti-B mannose glycoside antibody (AMCA) IgG, anti-B glycoside sugar shell antibody (ACCA) IgA, Anti-bacterial flagellin antibody (Anti-cBir1) IgG, and the fecal calprotectin (FC) were determined by Enzyme linked immunosorbent assay (ELISA). Results The positive rate of serum pANCA was 100% in 6 cases of UC while it was negative in CD cases and control, and there was significant difference among three groups (P < 0.01). In CD cases, both positive rate of serum ACCA IgA and that of Anti-cBir1-IgG were 62.5% and the positive rate of ACCA IgA was 37.5%. Meanwhile, all of them were negative in UC cases and control. There were significant differences among three groups (P<0.01). The positive rate of FC was 100% in children with IBD. It was significantly higher than the positive rate in control group, 54.2% (P < 0.01). Conclusion The serum pANCA is a specific index for the diagnosis of UC. The serum ACCA IgA, AMCA IgG, ASCA IgG and IgA, and Anti-cBir1 IgG were specific to some extent in the diagnosis of CD. Increased FC can reflect the activity of IBD, but cannot be used for the differential diagnosis of IBD and non IBD.