Ülseratif Kolit ve Crohn Hastalığı Ayırımında Serolojik Belirteçlerin Tanısal Değeri

Öz

Amaç: İnflamatuvar bağırsak hastalıklarının İBH tanısında noninvazif serolojik belirteçlerin rolü artmaktadır. Bu çalışmada, ülseratif kolit ÜK ve Crohn Hastalığı CH hastalığı tanılı hastalarda dört farklı otoantikorun ayırıcı tanıda kullanımının değerlendirilmesi amaçlanmıştır.Gereç ve Yöntemler: Çalışmaya 122 İBH tanılı hasta dahil edildi. Hastaların 70’i %57,3 ÜK, 52’si %42,7 CH tanılıydı. Hastaların demografik ve klinik verileri kaydedildi, anti nötrofil sitoplazmik antikor ANCA , anti-intestinal goblet antikoru AİGA , anti Saccharomyces cerevisiae antikoru ASCA ve anti-ekzokrin pankreatik antikoru AEPA immünflöresans yöntemi ile çalışıldı ve değerlendirildi. Veriler SPSS 17.0 programı ile analiz edildi. Bulgular: ANCA, ASCA ve AEPA antikorları ayırıcı tanıda yüksek özgüllüğe sırası ile %96,1, %94,2 ve %98,5 sahiptir. En yüksek test doğruluğu %73,7 ile ASCA’da izlenmekte olup, en düşük test doğruluğu %55,7 ile ANCA’da izlenmiştir. Ayrıca, ANCA pozitif ÜK hastalarının, ANCA negatif hastalardan ANCA pozitif 7,61±3,3 atak, ANCA negatif 4,98±3,3 atak ; ASCA pozitif CH hastaların da ASCA negatiflere oranla daha fazla sayıda atak geçirdiği ASCA pozitif 5,04±3,5 atak, ASCA negatif 3,3±1,9 atak izlenmektedir. Sonuç: ÜK ve CH ayırıcı tanısında ANCA, ASCA ve AEPA yüksek özgüllük ve pozitif prediktif değerlere sahiptir. Ancak, antikorların hasta popülasyonlarında pozitiflik oranlarının düşük olması nedeniyle klinik kullanımları kısıtlıdır. ANCA ve ASCA antikorlarının pozitifliği aynı zamanda ÜK ve CH atak sayısı ile ilişkili bulunmuş olup, şiddetli hastalık seyri hakkında prognostik öneme sahip olabilir

Anahtar Kelimeler

• Ülseratif kolit, Crohn Hastalığı, İnflamatuar bağırsak hastalıkları, Otoantikorlar, Ayırıcı tanı

Diagnostic Value of Serological Markers in Discriminating Ulcerative Colitis and Crohn's Disease

Abstract

Objective: The role of noninvasive serological markers is increasing in the diagnosis of inflammatory bowel diseases IBD . In this study, we aimed to evaluate the use of four different autoantibodies in the differential diagnosis in patients diagnosed with ulcerative colitis UC and Crohn's Disease CD .Material and Methods: 122 patients with IBD were included in the study. Seventy patients 57.3% were diagnosed with UC and 52 42.7% were diagnosed with CD. Demographic and clinical data were recorded; anti-neutrophil cytoplasmic antibody ANCA , anti-intestinal goblet antibody AIGA , anti Saccharomyces cerevisiae antibody, ASCA and anti-exocrine pancreatic antibody AEPA were studied using immunofluorescence. Data were analyzed with the SPSS 17.0 program.Results: ANCA, ASCA and AEPA antibodies had high specificities 96.1%, 94.2% and 98.5%, respectively . The highest test accuracy was seen in ASCA with 73.7%, and the lowest test accuracy was seen in ANCA with 55.7%. In addition, ANCA-positive UC patients had experienced more attacks than ANCA-negative patients ANCA-positive 7.61±3.3 attacks, ANCA-negative 4.98 ± 3.3 attacks ; similarly, ASCA positive CD patients also had more attacks than ASCA negatives ASCA positive 5.04±3.5 attacks, ASCA negative 3.3±1.9 attacks .Conclusion: ANCA, ASCA and AEPA have high specificity and positive predictive values in the differential diagnosis of UC and CD. However, their clinical use is limited due to the low positivity rates of antibodies in patient populations. The positivity of ANCA and ASCA antibodies has also been associated with the number of UC and CH attacks, and may have prognostic significance for the course of severe disease

Keywords

• Ulcerative Colitis, Crohn's Disease, Inflammatory bowel diseases, Autoantibodies, Differential diagnosis

Kaynakça

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