gastro-jРоссийский журнал гастроэнтерологии, гепатологии, колопроктологииRussian Journal of Gastroenterology, Hepatology, Coloproctology1382-43762658-6673«Gastro» LLCgastro-j-1734Research ArticleНОВОСТИ КОЛОПРОКТОЛОГИИNEWS OF COLOPROCTOLOGYПеринуклеарные антинейтрофильные цитоплазматические антитела у больных язвенным колитом и болезнью КронаPerinuclear antineutrophilic cytoplasmatic antibodies at patients with ulcerative colitis and Crohn’s diseaseКоновичЕ. А.KonovichYe. A.ХалифИ. Л.KhalifI. A.2009051020091957277Copyright © Конович Е.А., Халиф И.Л., 20092009Конович Е.А., Халиф И.Л.Konovich Y.A., Khalif I.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.gastro-j.ru/jour/article/view/1734

Цель исследования. Определение частоты обнаружения и уровня перинуклеарных антинейтрофильных цитоплазматических антител (pANCA) у больных язвенным колитом (ЯК) и болезнью Крона (БК) в зависимости от локализации и распространенности поражения толстой кишки, клинической активности, характера течения заболевания и применяемых методов лечения.Материал и методы. Обследованы 160 пациентов: 104 – с ЯК, 36 – с БК и 20 – с синдромом раздраженного кишечника (СРК). pANCA определяли в сыворотке крови больных методом непрямой иммунофлюоресценции на нейтрофилах, фиксированных этанолом (тест­система фирмы «Bio­Rad», США).Результаты. pANCA были обнаружены у 47,3, 25,0 и 5,0% больных ЯК, БК и СРК соответственно (р<0,001 – ЯК в сравнении с СРК, р<0,02 – БК в сравнении с СРК, р<0,05 – ЯК в сравнении с БК). При тотальной, левосторонней и дистальной формах ЯК они присутствовали у 47,7, 58,8 и 27,3% пациентов соответственно, при остром, хроническом рецидивирующем и хроническом непрерывном течении – у 14,3, 45,1 и 67,5% (р<0,001). У больных с тяжелым, среднетяжелым течением и в фазе ремиссии pANCA были выявлены в 42,8, 56,0 (р<0,05) и 20,0% случаев соответственно. Они обнаружены у 72,7% больных активным тотальным ЯК с хроническим непрерывным течением. Титр pANCA ≥ 1:80 наблюдался у 10 из 27 пациентов с хроническим непрерывным течением болезни и у 1 из 14 (р<0,05) с хроническим рецидивирующим течением. Частота pANCA имела тенденцию к увеличению у стероидрезистентных больных и к снижению после субтотальной колэктомии.pANCA выявлялись у 9 из 26 (34,6%) больных БК с поражением толстой кишки (илеоколит, БК толстой кишки) и отсутствовали у 10 (p<0,01) пациентов с развитием болезни в форме терминального илеита. Не установлено различий между подгруппами больных БК с выраженной активностью процесса и в фазе ремиссии.Выводы. Показано, что pANCA при ЯК в большей степени ассоциированы с распространенным поражением толстой кишки, фазой клинической активности и хроническим непрерывным течением с тенденцией к увеличению частоты выявления у стероидрезистентных больных и ее снижению после удаления пораженной толстой кишки.

Aim of investigation

Aim of investigation. Assessment of frequency and level of perinuclear antineutrophilic cytoplasmatic antibodies (pANCA) in patients with ulcerative colitis (UC) and Crohn’s disease (CD) in relation to location and spread of lesion of the large intestine, clinical activity, course of disease and applied treatment methods.

Material and methods

Material and methods. Overall 160 patients were investigated: 104 – with UC, 36 – with CD and 20 – with irritable bowel syndrome (IBS). pANCA were determined in blood serum of patients by indirect immunofluorescence method on ethanol-fixed neutrophiles («Bio-Rad» test-system, USA).

Results

Results. pANCA have been found in 47,3, 25,0 and 5,0% of patients with UC, CD and IBS respectively (р<0,001 – UC in comparison to IBS, р<0,02 – CD in comparison to IBS, р<0,05 – UC in comparison to CD). At total, left-sided and distal forms of UC they were present in 47,7, 58,8 and 27,3% of patients respectively, at acute, chronic relapsing and chronic persistent course – in 14,3, 45,1 and 67,5% (р<0,001). In patients with severe, moderate course and in phase of remission pANCA have been revealed in 42,8, 56,0 (р<0,05) and 20,0% of cases respectively. They were found in 72,7% of patients with active total UC with chronic persistent course. pANCA titer of >1:80 was observed in 10 of 27 patients with chronic persistent course of disease and in 1 of 14 (р<0,05) with chronic recurrent course. Frequency of pANCA has tendency to increase in steroid-resistant patients and to decrease after subtotal colectomy. pANCA were found in 9 of 26 (34,6 %) patients with CD with large intestinal lesion (ileocolitis, CD of the large intestine) and were absent in 10 (p<0,01) patients with terminal ileitis. No difference between subgroups of patients with CD with high activity of process and in phase of remission was revealed.

Conclusions

Conclusions. It was demonstrated, that at UC pANCA in greater degree are associated to diffuse lesion of the large intestine, phase of clinical activity and chronic persistent course with tendency to increase in frequency at steroid-resistant patients and to decrease after resection of affected large intestine.

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The authors declare that there are no conflicts of interest present.