抗核周型粒细胞胞浆抗体及抗小肠杯状细胞抗体在溃疡性结肠炎诊断中的临床价值

发布时间：2018-03-18 16:00

本文选题：溃疡性结肠炎　切入点：临床特征　出处：《大连医科大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的：观察抗核周型粒细胞胞浆抗体（pANCA）及抗小肠杯状细胞抗体（GAB）在溃疡性结肠炎（ulcerative colitis，UC）患者中的表达，探讨其在UC诊断中的临床价值。方法：根据2012年广州中国炎症性肠病诊断治疗规范的诊治意见中制定的标准对我院2009.1.1~2014.1.1首次入住的200例UC患者进行回顾性临床分析，包括基本资料、病情程度、病程、病变范围、临床类型及肠外表现等，以间接免疫荧光法（IIF）检测患者血清pNACA、GAB的表达，分析pNACA、GAB在UC诊断中的临床意义。结果：本组200例UC患者中男性112例，女性88例，，男：女之比约为1.27:1。pNACA阳性率分别为27.5%（55/200）、23.5%（47/200），GAB为19.0%（38/200）、14.5%（29/200），其在男女两组间的比较均无统计学意义（P=0.571，P=1.000）。本组病人入院年龄16~77（46±15）岁，发病年龄5~76（43±15）岁，发病高峰多见于40~49岁（49/200，24.5%），呈单峰分布。将年龄分为＜40岁、≥40岁两组，pNACA在两组中的阳性率分别为18.5%（37/200）、32.5%（65/200），两组比较无统计学意义（P=0.828）；而GAB为11.5%（23/200）、22.0%（44/200），两组比较亦无统计学意义（P=0.643）。本组资料中以慢性复发型（116/200，58%）最多见。pNACA在初发型和慢性复发型中的阳性率分别为17.5%（35/200）、33.5%（67/200），GAB为15.0%（30/200）、18.5%（37/200），其在两组间比较均无统计学意义（P=1.000，P=0.649）。本组200例UC患者以轻度（116/200，58.0%）、中度（67/200，33.5%）为主，在轻、中、重度三型pNACA阳性率分别为26.5%（53/200）、19.0%（38/200）、5.5%（11/200），GAB为21.0%（42/200）、10.5%（21/200）、2.0%（4/200）。其在三组间pNACA、GAB的比较均无统计学意义（P=0.177，P=0.527）。本组200例UC患者病变范围依次为左半结肠（86/200，43.0%）＞广泛结肠（66/200，33.0%）＞直肠（48/200，24.0%）。pNACA阳性率分别为22.0%（44/200）、18.5%（37/200）、10.5%（21/200），GAB为15.5%（31/200）、7.5%（15/200）、10.5%（21/200），其在三组间的比较均无统计学意义（P=0.43，P=0.051）。本组200例UC患者以活动期为主（194/200，97.0%），其pNACA、GAB阳性率分别为50.0%（100/200）、32.0%（64/200）。pNACA、GAB阳性在活动期、缓解期两组间的比较均无统计学意义（P=0.438，P=0.404）。本组资料中有肠外表现者占3.0%（6/200），其中含2项或以上者1例（同时具备口腔溃疡、皮疹、关节痛），肝胆疾病2例，口腔溃疡2例，关节疼痛2例，皮疹2例。pNACA、GAB在肠外表现中的阳性率分别为1.5%（3/200）、0.5%（1/200），其在有无肠外表现两组间的比较均无统计学意义（P=1.000，P=0.666）。在本组资料中还发现病变范围和病情严重程度总体差异具有统计学意义（P＜0.001），继续组间两两比较，P＜0.001，差异均有统计学意义，即病变范围累及越广，病情越严重。本组200例UC患者中pNACA、GAB阳性率分别为51%（102/200）、33.5%（67/200），两者均阳性的比例为19.0%（38/200），pNACA阳性时GAB阳性率为37.3%（38/102），GAB阳性时pNACA阳性率为56.7%（38/67）。在本组200例UC患者中发现pNACA在病情严重及病变部位广泛的病人中表达显著升高，其在重度广泛结肠中阳性率最高，为75.00%（6/8）。结论：1. pNACA、GAB阳性与年龄、性别、病情程度、临床类型、病变范围、病情分期、肠外表现等无关（P＞0.05）。 2. pNACA、GAB的表达可协助UC的诊断，但由于其阳性率较低，不适宜UC的临床筛查。 3.pNACA在病情严重及病变部位广泛的病人中表达显著升高，pNACA（+）可能是UC发病的独立危险因素，对判断病情、指导临床有重要价值。 4.联合检测pANCA、GAB不但可以提高各自的表达率，而且可以提高UC的诊断率。
[Abstract]:Objective: To observe the expression of antinuclear granulocyte cytoplasmic antibody (pANCA) and anti small intestinal goblet cell antibody (GAB) in patients with ulcerative colitis (UC), and to explore its clinical value in the diagnosis of UC.
Methods: 200 cases of UC patients according to the 2012 Guangzhou China inflammatory bowel disease diagnosis and treatment standard diagnosis and treatment standard in 2009.1.1~2014.1.1 of our hospital for the first time admitted were analyzed retrospectively, including basic information, disease severity, duration of disease, extent of disease, clinical type and extraintestinal manifestations, by indirect immunofluorescence (IIF) the serum pNACA, the expression of GAB, pNACA analysis, GAB and clinical significance in the diagnosis of UC.
Results: in 200 cases of UC, there were 112 males and 88 females. The ratio of male to female was 1.27:1.pNACA, the positive rate was 27.5% (55/200), 23.5% (47/200), GAB was 19% (38/200), 14.5% (29/200), there was no statistically significant difference between male and female two groups (P= 0.571, P=1.000).
This group of patients were aged 16~77 (46 + 15) years old, the age of onset of 5~76 (43 + 15) years of age, the peak incidence in 40~49 years (49/200,24.5%), unimodal. The age is less than 40 years, more than 40 years old in two groups, the positive rate of pNACA in the two groups were 18.5% (37/200), 32.5% (65/200), the two groups were not statistically significant (P=0.828); and GAB is 11.5% (23/200), 22% (44/200), the two groups had no statistical significance (P=0.643).
In the data,.PNACA was the most frequent in chronic reoccurrence (116/200,58%). The positive rate of.PNACA in the first onset and chronic relapse type was 17.5% (35/200), 33.5% (67/200), GAB was 15% (30/200), and 18.5% (37/200), there was no statistically significant difference between the two groups (P= 1, P=0.649).
This group of 200 cases of UC patients with mild to moderate (116/200,58.0%), (67/200,33.5%), in the light of severe type three pNACA positive rates were 26.5% (53/200), 19% (38/200), 5.5% (11/200), GAB 21% (42/200), 10.5% (21/200), 2% (4/200). PNACA in the three groups, GAB were not statistically significant (P=0.177, P=0.527).
This group of 200 patients with UC lesions in the left colon (86/200,43.0%), (66/200,33.0%), extensive colon rectum (48/200,24.0%) positive rate of.PNACA was 22% (44/200), 18.5% (37/200), 10.5% (21/200), GAB 15.5% (31/200), 7.5% (15/200), 10.5% (21/200). In the comparison between the three groups were not statistically significant (P=0.43, P=0.051).
In this group, 200 cases of UC were mainly active stage (194/200,97.0%), the positive rate of pNACA and GAB were 50% (100/200), 32% (64/200).PNACA, GAB positive in the active phase and remission phase, there was no significant difference between the two groups (P=0.438, P=0.404).
Intestinal manifestations in this group accounted for 3% (6/200), which contains 2 or more (1 cases with oral ulcer, rash, arthralgia), 2 patients with liver disease, 2 cases of oral ulcer, 2 cases of joint pain, rash, 2 cases of.PNACA, the positive rate of GAB expression in parenteral in were 1.5% (3/200), 0.5% (1/200), which in the presence of extraintestinal manifestations between the two groups were not statistically significant (P=1.000, P=0.666).
In this group of data, it was found that the overall difference between lesion size and severity was statistically significant (P < 0.001). The difference between the 22 groups was P < 0.001, the difference was statistically significant, that is, the wider the lesion area, the more serious the disease.
The positive rates of pNACA and GAB in 200 patients with UC were 51% (102/200) and 33.5% (67/200), respectively. The proportion of both positive patients was 19% (38/200). The positive rate of GAB was 37.3% (38/102) when pNACA was positive, while the positive rate of pNACA was 56.7% (GAB) when GAB positive.
In 200 cases of UC, pNACA was found to be significantly increased in patients with severe disease and extensive lesions. The highest positive rate was 75% (6/8) in severe colon.
Conclusion: 1. pNACA and GAB positive are not related to age, sex, degree of disease, clinical type, pathological range, stage of disease, and expression of extra intestinal (P > 0.05).
The expression of 2. pNACA, GAB can assist in the diagnosis of UC, but because of its low positive rate, it is not suitable for the clinical screening of UC.
3.pNACA was significantly increased in patients with severe disease and extensive lesions. PNACA (+) may be an independent risk factor for UC, which is of great value in judging the disease and guiding the clinical practice.
4. combined detection of pANCA, GAB can not only improve the rate of expression, but also improve the diagnostic rate of UC.

【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R574.62

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