pANCA and ASCA in Children with IBD-Unclassified, Crohn's Colitis, and Ulcerative ColitisA Longitudinal Report from the IBD Porto Group of ESPGHAN

被引：29

作者：

Birimberg-Schwartz, Liron ^{[1
]}

Wilson, David C. ^{[2
]}

Kolho, Kaija-Leena ^{[3
]}

Karolewska-Bochenek, Katarzyna ^{[4
]}

Afzal, Nadeem Ahmad ^{[5
]}

Spray, Christine ^{[6
]}

Romano, Claudio ^{[7
]}

Lionetti, Paolo ^{[8
]}

Hauer, Almuthe C. ^{[9
]}

Martinez-Vinson, Christine ^{[10
]}

Veres, Gabor ^{[11
]}

Escher, Johanna C. ^{[12
]}

Turner, Dan ^{[13
]}

机构：

[1] Shaare Zedek Med Ctr, Jerusalem, Israel

[2] Univ Edinburgh, Child Life & Hlth, Edinburgh EH8 9YL, Midlothian, Scotland

[3] Univ Helsinki, FIN-00014 Helsinki, Finland

[4] Med Univ, Dept Pediat Gastroenterol, Warsaw, Poland

[5] Southampton Univ Hosp, Southampton, Hants, England

[6] Univ Hosp Bristol, Bristol, Scotland

[7] Univ Messina, I-98100 Messina, Italy

[8] Univ Florence, I-50121 Florence, Italy

[9] Med Univ Graz, Univ Hosp Pediat & Adolescent Med, Graz, Austria

[10] Robert Debre Hosp, Dept Pediat Gastroenterol & Nutr, Paris, France

[11] Semmelweis Univ, Budapest, Hungary

[12] Erasmus MC, Rotterdam, Netherlands

[13] Hebrew Univ Jerusalem, IL-91905 Jerusalem, Israel

来源：

INFLAMMATORY BOWEL DISEASES | 2016年 / 22卷 / 08期

基金：

英国医学研究理事会;

关键词：

pediatrics; IBDU; Crohn's colitis; UC; ANCA; ASCA; prediction; INFLAMMATORY-BOWEL-DISEASE; ANTI-SACCHAROMYCES-CEREVISIAE; ANTINEUTROPHIL CYTOPLASMIC ANTIBODIES; SEROLOGICAL MARKERS; INDETERMINATE COLITIS; CLINICAL-COURSE; DIAGNOSIS; UTILITY; RISK; AUTOANTIBODIES;

D O I：

10.1097/MIB.0000000000000784

中图分类号：

R57 [消化系及腹部疾病];

学科分类号：

摘要：

Introduction:No study to date has evaluated perinuclear antineutrophil cytoplasmic antibody (pANCA) and anti-Saccharomyces cerevisiae antibody (ASCA) in pediatric inflammatory bowel disease-unclassified (IBDU) as compared with Crohn's colitis (CC) and ulcerative colitis (UC), which represent the diagnostic challenge. We aimed to explore the diagnostic utility of serology and to assess whether serology can predict disease severity in these subgroups.Methods:This was a multicenter retrospective longitudinal study including 406 children with inflammatory bowel diseases (IBD) from 23 centers affiliated with the Porto group of European Society of Pediatric Gastroenterology, Hepatology and Nutrition (mean age 10.5 3.9, 54% males); 117 (29%) with CC, 143 (35%) with UC, and 146 (36%) with IBDU. Median follow-up period was 2.8 years (interquartile range, 1.6-4.2).Results:The most prevalent serologic profile in IBDU was pANCA-/ASCA- (41%), followed by pANCA+/ASCA- (34%) and pANCA-/ASCA+ (17%). pANCA-/ASCA+ differentiated well between CC versus IBDU (83% specificity, 96% positive predictive value [PPV]) and UC (97% specificity, 90% PPV) patients, albeit with a low negative predictive value (13% and 40%, respectively). pANCA+/ASCA- did not differentiate as well between IBD subgroups, but UC children with pANCA+/ASCA- had more often severe disease at diagnosis (36 [62%] versus 22 [38%], P = 0.033) and needed more often calcineurin inhibitors, biologics, or colectomy (25 [80%] versus 6 [20%], P = 0.026). In CC, double positivity for ASCA and not pANCA-/ASCA+ profile was associated with disease severity.Conclusions:Serology may have some role in predicting disease course and outcomes in colonic IBD, but its routine use needs to be supported by more studies. Serology cannot routinely be recommended for differentiating between IBDU versus CC or UC as a sole diagnostic criterion given its low diagnostic utility.

引用

页码：1908 / 1914

页数：7

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