Ülseratif Kolit ve Crohn Hastalığı Ayırımında Serolojik Belirteçlerin Tanısal Değeri

Yıl 2021, Cilt: 7 Sayı: 1, 96 - 102, 01.01.2021

Mehmet Bakırtaş Gökhan Tazegül Esvet Mutlu Meral Gültekin Bülent Yıldırım

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

Öz

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

Anahtar Kelimeler

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

Kaynakça

• Escher JC, Dias JA, Bochenek K, Buderus S, de Mesquita MB, Bujanover Y, Buller HA, Chong SKF, Cucchiara S, Fell JME, Henker J, Hildebrand H, Hugot JP, Jedynak U, Jenkins H, Kolaček S, Koletzko S, Lazowska I, Levine A, Lionetti P, Maly J, Montgomery SM, Murch SH, Murphy MS, Paerregaard A, Sandhu BK, Sawczenko A. Inflammatory bowel disease in children and adolescents: Recommendations for diagnosis-the Porto criteria. J Pediatr Gastroenterol Nutr 2005; 41(1):1-7.
• Jung SA. Differential diagnosis of inflammatory bowel disease: What is the role of colonoscopy? Clin Endosc 2012; 45(3):254-62.
• Papadakis KA, Tabibzadeh S. Diagnosis and misdiagnosis of inflammatory bowel disease. Gastrointest Endosc Clin 2002; 12(3):433-49.
• Tesija Kuna A. Serological markers of inflammatory bowel disease. Biochem Med (Zagreb) 2013; 23(1):28-42.
• Lewis JD, Chuai S, Nessel L, Lichtenstein GR, Aberra FN, Ellenberg JH. Use of the noninvasive components of the Mayo score to assess clinical response in ulcerative colitis. Inflamm Bowel Dis 2008; 14(12):1660-6.
• Yoshida EM. The Crohn’s disease activity index, its derivatives and the inflammatory bowel disease questionnaire: A review of instruments to assess Crohn’s disease. Can J Gastroenterol 1999; 13(1):65-73.
• El‐Matary W, Dupuis K, Sokoro A. Anti‐S accharomyces cerevisiae antibody titres correlate well with disease activity in children with Crohn’s disease. Acta Paediatr 2015; 104(8):827-30.
• Koutroubakis IE, Drygiannakis D, Karmiris K, Drygiannakis I, Makreas S, Kouroumalis EA. Pancreatic autoantibodies in Greek patients with inflammatory bowel disease. Dig Dis Sci 2005; 50(12):2330-4.
• Peeters M, Joossens S, Vermeire S, Vlietinck R, Bossuyt X, Rutgeerts P. Diagnostic value of anti-Saccharomyces cerevisiae and antineutrophil cytoplasmic autoantibodies in inflammatory bowel disease. Am J Gastroenterol 2001; 96(3):730-4.
• Quinton JF, Sendid B, Reumaux D, Duthilleul P, Cortot A, Grandbastien B, Charrier G, Targan SR, Colombel JF, Poulain D. Anti-Saccharomyces cerevisiae mannan antibodies combined with antineutrophil cytoplasmic autoantibodies in inflammatory bowel disease: Prevalence and diagnostic role. Gut 1998; 42(6):788-91.
• Mokrowiecka A, Daniel P, Slomka M, Majak P, Malecka-Panas E. Clinical utility of serological markers in inflammatory bowel disease. Hepatogastroenterology 2009; 56(89):162-6.
• Reese GE, Constantinides VA, Simillis C, Darzi AW, Orchard TR, Fazio VW, Tekkis PP. Diagnostic precision of anti-Saccharomyces cerevisiae antibodies and perinuclear antineutrophil cytoplasmic antibodies in inflammatory bowel disease. Am J Gastroenterol 2006; 101(10):2410-22.
• Mutar Mahdi B. Auto-antibodies in patients with inflammatory bowel disease unclassified. Iran J Immunol 2011; 8(3):189-94.
• Zhou G, Song Y, Yang W, Guo Y, Fang L, Chen Y, Liu Z. ASCA, ANCA, ALCA and many more: Are they useful in the diagnosis of inflammatory bowel disease? Dig Dis 2016; 34(1-2):90-7.
• Vermeire S, Joossens S, Peeters M, Monsuur F, Marien G, Bossuyt X, Groenen P, Vlietinck R, Rutgeerts P. Comparative study of ASCA (Anti-Saccharomyces cerevisiae antibody) assays in inflammatory bowel disease. Gastroenterology 2001; 120(4): 827-33.
• Roggenbuck D, Reinhold D, Schierack P, Bogdanos DP, Conrad K, Laass MW. Crohn’s disease specific pancreatic antibodies: Clinical and pathophysiological challenges. Clin Chem Lab Med 2014; 52(4):483-94.
• Tatar E, Çekiç C, İpek S, Vatansever S, Demir S, Topal F, Ersil Soysal D, Ünsal B. Anti-pankreatik antikor, anti- nötrofil sitoplazmik antikor ve anti-Saccharomyces cere- visiae antikorlarının inflamatuvar barsak hastalıklarındaki tanısal değeri ve hastalık aktivitesi ile ilişkilerinin değerlen- dirilmesi. Akad Gastroenteroloji Derg 2013; 12(2):69-73.
• Erzin Y, Çelik AF, Karatoka B, Aslan M, Kocazeybek B. Plazma goblet hücre ve ekzokrin pankreas antikor sıklığının Crohn hastalığı ve ülseratif kolit ayırımındaki klinik değeri. Cerrahpaşa Tıp Derg 2008; 39(1):27-32.
• Prideaux L, De Cruz P, Ng SC, Kamm MA. Serological antibodies in inflammatory bowel disease: A systematic review. Inflamm Bowel Dis 2012; 18(7):1340-55.
• Mokhtarifar A, Ganji A, Sadrneshin M, Bahari A, Esmaeilzadeh A, Ghafarzadegan K, Nikpour S. Diagnostic value of ASCA and atypical p-ANCA in differential diagnosis of inflammatory bowel disease. Middle East J Dig Dis 2013; 5(2):93-7.
• Annese V, Andreoli A, Andriulli A, D’Inca R, Gionchetti P, Latiano A, Lombardi G, Piepoli A, Poulain D, Sendid B, Colombel JF. Familial expression of anti-saccharomyces cerevisiae mannan antibodies in Crohn’s disease and ulcerative colitis: A GISC study. Am J Gastroenterol 2001; 96(8):2407-12.
• Schulte-Pelkum J, Radice A, Norman GL, Lόpez Hoyos M, Lakos G, Buchner C, Musset L, Miyara M, Stinton L, Mahler M. Novel clinical and diagnostic aspects of antineutrophil cytoplasmic antibodies. J Immunol Res 2014; 2014:185416.
• Papp M, Altorjay I, Lakos G, Tumpek J, Sipka S, Dinya T, Palatka K, Veres G, Udvardy M, Lakatos PL. Evaluation of the combined application of ethanol-fixed and formaldehyde-fixed neutrophil substrates for identifying atypical perinuclear antineutrophil cytoplasmic antibodies in inflammatory bowel disease. Clin Vaccine Immunol 2009; 16(4):464-70.
• Birimberg-Schwartz L, Wilson DC, Kolho K-L, Karolewska-Bochenek K, Afzal NA, Spray C, Romano C, Lionetti P, Hauer AC, Martinez-Vinson C, Veres G, Escher JC, Turner D, Paediatric IBD Porto Group of ESPGHAN. pANCA and ASCA in children with IBD-unclassified, Crohn’s colitis, and ulcerative colitis-a longitudinal report from the IBD Porto Group of ESPGHAN. Inflamm Bowel Dis 2016; 22(8):1908-14.