發(fā)布時間：2018-03-18 16:00

  本文選題：潰瘍性結(jié)腸炎　切入點：臨床特征　出處：《大連醫(yī)科大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：目的：觀察抗核周型粒細(xì)胞胞漿抗體（pANCA）及抗小腸杯狀細(xì)胞抗體（GAB）在潰瘍性結(jié)腸炎（ulcerative colitis，UC）患者中的表達(dá)，探討其在UC診斷中的臨床價值。 方法：根據(jù)2012年廣州中國炎癥性腸病診斷治療規(guī)范的診治意見中制定的標(biāo)準(zhǔn)對我院2009.1.1~2014.1.1首次入住的200例UC患者進(jìn)行回顧性臨床分析，包括基本資料、病情程度、病程、病變范圍、臨床類型及腸外表現(xiàn)等，以間接免疫熒光法（IIF）檢測患者血清pNACA、GAB的表達(dá)，分析pNACA、GAB在UC診斷中的臨床意義。 結(jié)果：本組200例UC患者中男性112例，女性88例，，男：女之比約為1.27:1。pNACA陽性率分別為27.5%（55/200）、23.5%（47/200），GAB為19.0%（38/200）、14.5%（29/200），其在男女兩組間的比較均無統(tǒng)計學(xué)意義（P=0.571，P=1.000）。 本組病人入院年齡16~77（46±15）歲，發(fā)病年齡5~76（43±15）歲，發(fā)病高峰多見于40~49歲（49/200，24.5%），呈單峰分布。將年齡分為＜40歲、≥40歲兩組，pNACA在兩組中的陽性率分別為18.5%（37/200）、32.5%（65/200），兩組比較無統(tǒng)計學(xué)意義（P=0.828）；而GAB為11.5%（23/200）、22.0%（44/200），兩組比較亦無統(tǒng)計學(xué)意義（P=0.643）。 本組資料中以慢性復(fù)發(fā)型（116/200，58%）最多見。pNACA在初發(fā)型和慢性復(fù)發(fā)型中的陽性率分別為17.5%（35/200）、33.5%（67/200），GAB為15.0%（30/200）、18.5%（37/200），其在兩組間比較均無統(tǒng)計學(xué)意義（P=1.000，P=0.649）。 本組200例UC患者以輕度（116/200，58.0%）、中度（67/200，33.5%）為主，在輕、中、重度三型pNACA陽性率分別為26.5%（53/200）、19.0%（38/200）、5.5%（11/200），GAB為21.0%（42/200）、10.5%（21/200）、2.0%（4/200）。其在三組間pNACA、GAB的比較均無統(tǒng)計學(xué)意義（P=0.177，P=0.527）。 本組200例UC患者病變范圍依次為左半結(jié)腸（86/200，43.0%）＞廣泛結(jié)腸（66/200，33.0%）＞直腸（48/200，24.0%）。pNACA陽性率分別為22.0%（44/200）、18.5%（37/200）、10.5%（21/200），GAB為15.5%（31/200）、7.5%（15/200）、10.5%（21/200），其在三組間的比較均無統(tǒng)計學(xué)意義（P=0.43，P=0.051）。 本組200例UC患者以活動期為主（194/200，97.0%），其pNACA、GAB陽性率分別為50.0%（100/200）、32.0%（64/200）。pNACA、GAB陽性在活動期、緩解期兩組間的比較均無統(tǒng)計學(xué)意義（P=0.438，P=0.404）。 本組資料中有腸外表現(xiàn)者占3.0%（6/200），其中含2項或以上者1例（同時具備口腔潰瘍、皮疹、關(guān)節(jié)痛），肝膽疾病2例，口腔潰瘍2例，關(guān)節(jié)疼痛2例，皮疹2例。pNACA、GAB在腸外表現(xiàn)中的陽性率分別為1.5%（3/200）、0.5%（1/200），其在有無腸外表現(xiàn)兩組間的比較均無統(tǒng)計學(xué)意義（P=1.000，P=0.666）。 在本組資料中還發(fā)現(xiàn)病變范圍和病情嚴(yán)重程度總體差異具有統(tǒng)計學(xué)意義（P＜0.001），繼續(xù)組間兩兩比較，P＜0.001，差異均有統(tǒng)計學(xué)意義，即病變范圍累及越廣，病情越嚴(yán)重。 本組200例UC患者中pNACA、GAB陽性率分別為51%（102/200）、33.5%（67/200），兩者均陽性的比例為19.0%（38/200），pNACA陽性時GAB陽性率為37.3%（38/102），GAB陽性時pNACA陽性率為56.7%（38/67）。 在本組200例UC患者中發(fā)現(xiàn)pNACA在病情嚴(yán)重及病變部位廣泛的病人中表達(dá)顯著升高，其在重度廣泛結(jié)腸中陽性率最高，為75.00%（6/8）。 結(jié)論：1. pNACA、GAB陽性與年齡、性別、病情程度、臨床類型、病變范圍、病情分期、腸外表現(xiàn)等無關(guān)（P＞0.05）。 2. pNACA、GAB的表達(dá)可協(xié)助UC的診斷，但由于其陽性率較低，不適宜UC的臨床篩查。 3.pNACA在病情嚴(yán)重及病變部位廣泛的病人中表達(dá)顯著升高，pNACA（+）可能是UC發(fā)病的獨立危險因素，對判斷病情、指導(dǎo)臨床有重要價值。 4.聯(lián)合檢測pANCA、GAB不但可以提高各自的表達(dá)率，而且可以提高UC的診斷率。
[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.

【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R574.62

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