炎症性肠病病人中乳糜泻特异性抗体、Dectin-1受体检测及其相关性分析

发布时间：2018-02-26 03:00

本文关键词： 炎症性肠病溃疡性结肠炎克罗恩病慢性腹泻谷氨酰胺转移酶抗体 Dectin-1受体　出处：《山西医科大学》2014年硕士论文　论文类型：学位论文

【摘要】：背景炎症性肠病（inflammatory bowel disease，IBD）是一组病因尚不十分清楚的慢性非特异性肠道炎症性疾病，包括溃疡性结肠炎（UC）和克罗恩病（CD）。现病因不清，可能为免疫紊乱所致,近年来我国IBD患者逐渐增加[1]。乳糜泻（celiac disease）是一种以腹泻为主要临床表现的由于摄入麦胶蛋白诱发的、具有遗传易感性的常见炎症性肠病，且常合并自身免疫性疾病[2]，亦严重影响病人健康。近年研究表明乳糜泻在全世界范围内均有分布，我国相关研究尚少。肠道中存在大量固有真菌，参与肠道炎症反应。Dectin-1受体是识别真菌的主要受体，其表达与IBD发病机制的关系尚待研究。研究目的检测乳糜泻特异性抗体组织型谷氨酰胺转移酶抗体（tTG）IgA及IgG，Dectin-1受体及抗中性粒细胞胞浆抗体(p-ANCA）、抗酿酒酵母抗体(ASCA)在IBD患者、慢性腹泻患者及同期健康对照者(Health control，HC)外周血中的检出情况，并分析其可能相关性。病例与方法 1.乳糜泻特异性抗体的检测及临床分析 1.1按中国炎症性肠病诊断治疗规范的共识意见选取我院住院及门诊确诊的炎症性肠病（IBD）患者115例，慢性腹泻患者112例及同期健康体检者95例。采集各组成员的外周静脉血4ml，，离心取血清备用。 1.2采用ELISA法对各组成员进行外周血清tTGIgA、tTGIgG抗体检测，分析阳性患者的临床特征。 2. Dectin-1受体检测及临床分析 2.1Dectin-1受体检测中IBD组为101例，余组与前相同。采集各组成员的外周静脉血4ml，离心取血清备用。 2.2采用ELISA法检测外周血清中的Dectin-1受体表达情况。结果 1.乳糜泻特异性抗体检测及临床分析 IBD组血清tTGIg阳性率为5.22%(6/115)，慢性腹泻组为5.36%(6/112)，对照组为3.16%(3/95)。有腹泻症状（IBD及慢性腹泻组）患病率为5.29%(12/227)。 2. Dectin-1受体检测及临床分析 IBD组、慢性腹泻组及健康对照组间Dectin-1异常表达率分别为79.20%(80/101)，80.35%（90/112），34.74%（3/95），2=59.44，P＜0.05。IBD组及慢性腹泻组Dectin-1的表达水平均明显低于健康对照组，但IBD组与慢性腹泻组间无明显差别。 p-ANCA、ASCA阴性UC患者的Dectin-1异常表达率分别为86.0%(43/50)、79.22%（61/77），p-ANCA、ASCA阴性CD患者的Dectin-1异常表达率均为66.67%(14/21)，p-ANCA阳性UC患者的Dectin-1异常表达率为66.67%(20/30),ASCA阳性UC患者的Dectin-1异常表达率为100%（3/3）。提示Dectin-1与传统的炎症性肠病血清学检测对诊断IBD（特别是CD）可能有一定的互补性。 Dectin-1的异常表达与UC严重程度相关性分析，r，=-0.035，P=0.752。与CD的严重程度相关性分析，r，=-0.093，P=0.687。结论 1.本研究结果提示在IBD、慢性腹泻患者中乳糜泻检出率为5.29%(12/227)，高于正常对照组3.16%（3/95），表明IBD、慢性腹泻患者中同时患乳糜泻的几率较高，临床诊疗中应给以高度重视。 2.与正常健康对照组相较，IBD、慢性腹泻组Dectin-1受体表达水平下降，推测Dectin-1受体可能与部分IBD及慢性腹泻的发生、发展有相关性。值得注意的是Dectin-1受体的异常改变可能与传统的炎症性肠病血清学检测指标有互补关系，但与IBD的严重程度无关。
[Abstract]:Background: inflammatory bowel disease (inflammatory bowel, disease, IBD) is a group of unknown etiology of chronic nonspecific intestinal inflammatory disease, including ulcerative colitis (UC) and Crohn's disease (CD). The etiology is not clear, may be caused by immune dysfunction, in recent years, Chinese IBD patients increased [1]. in celiac disease (celiac disease) is a kind of expression with diarrhea as the main clinical due to ingestion of gliadin induced, with genetic susceptibility to common inflammatory bowel disease, which is usually associated with autoimmune diseases, [2], also seriously affect the health of the patients. In recent years research shows that celiac disease worldwidewere distributed, related research in China is small. There are a lot of natural fungi in the gut, intestinal inflammation in.Dectin-1 receptor is the major receptor recognition of fungi, the relationship between the expression and the pathogenesis of IBD remains to be investigated.
Objective: to detect the celiac disease specific antibody of tissue transglutaminase antibody (tTG) IgA and IgG, Dectin-1 receptor and anti neutrophil cytoplasmic antibody (p-ANCA), anti Saccharomyces cerevisiae antibody (ASCA) in patients with IBD, chronic diarrhea patients and healthy controls (Health, control, HC) detection of peripheral in the blood, and to analyze the possible correlation.
Cases and methods
1. detection and clinical analysis of specific antibodies against celiac disease
1.1, according to the consensus of diagnosis and treatment of inflammatory bowel disease in China, 115 cases of inflammatory bowel disease (IBD) diagnosed in our hospital and 112 cases of chronic diarrhea and 95 cases of healthy persons in the same period were selected. The peripheral venous blood 4ml of each group was collected, and the serum was centrifuged.
1.2 the serum tTGIgA and tTGIgG antibodies were detected by ELISA, and the clinical characteristics of the positive patients were analyzed.
Detection and clinical analysis of 2. Dectin-1 receptor
In the detection of 2.1Dectin-1 receptor, group IBD was 101, and the remaining group was the same as before. The peripheral venous blood of the members of each group was collected and 4ml was collected by centrifugation.
2.2 the expression of Dectin-1 receptor in peripheral serum was detected by ELISA method.
Result
1. specific antibody detection and clinical analysis of celiac disease
The positive rate of serum tTGIg in group IBD was 5.22% (6/115), chronic diarrhea group was 5.36% (6/112), and the control group was 3.16% (3/95). The prevalence of diarrhea symptoms (IBD and chronic diarrhea group) was 5.29% (12/227).
Detection and clinical analysis of 2. Dectin-1 receptor
IBD group, chronic diarrhea group and healthy control group between the abnormal expression rate of Dectin-1 was 79.20% (80/101), 80.35% (90/112), 34.74% (3/95), 2=59.44, the expression level of P < 0.05.IBD group and chronic diarrhea group Dectin-1 were significantly lower than the healthy control group, but IBD group and chronic diarrhea was not significantly different between.
P-ANCA, ASCA negative patients with UC abnormal expression rate of Dectin-1 was 86% (43/50), 79.22% (61/77), p-ANCA, ASCA negative patients with CD abnormal expression rate of Dectin-1 was 66.67% (14/21), p-ANCA positive patients with UC abnormal expression rate of Dectin-1 was 66.67% (20/30), ASCA positive UC patients with abnormal expression of Dectin-1 the rate was 100% (3/3). Dectin-1 with the traditional IBD serological test for the diagnosis of IBD (especially CD) may have a certain complementarity.
Correlation analysis of abnormal expression of Dectin-1 and UC severity, correlation analysis of severity of R, =-0.035, P=0.752. and CD, R, =-0.093, P=0.687.
conclusion
1., the results of this study suggest that in IBD, the detection rate of chylous disease in chronic diarrhea patients is 5.29% (12/227), which is higher than that in the normal control group 3.16% (3/95), indicating that IBD has a higher risk of celiac disease in patients with chronic diarrhea, and should be highly regarded in clinical diagnosis and treatment.
And 2. normal healthy control group compared to IBD, the expression level of Dectin-1 receptor in chronic diarrhea group decreased, suggesting that Dectin-1 receptors may be associated with IBD and chronic diarrhea occurs, there is a correlation between the development. It is worth noting that the abnormal changes of Dectin-1 receptor may have a complementary relationship with the detection of serological indicator of inflammatory bowel disease traditional, but with the severity of IBD has nothing to do.

【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R574

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