medalphabetМедицинский алфавитMedical alphabet2078-56312949-2807ООО «Альфмед»10.33667/2078-5631-2025-5-26-33medalphabet-4238Research ArticleСОВРЕМЕННАЯ ЛАБОРАТОРИЯMODERN LABORATORYКлинико-диагностическая и прогностическая значимость панкреатических аутоантител и антител к бокаловидным клеткам кишечника при воспалительных заболеваниях кишечникаDiagnostic and prognostic significance of pancreatic autoantibodies and intestinal goblet cell antibodies in inflammatory bowel diseasesКузнецоваД. А.KuznetsovaD. A.

Кузнецова Дарья Александровна, к. м. н., врач клинической лабораторной диагностики лаборатории диагностики аутоиммунных заболеваний НМЦ молекулярной медицины Минздрава России

Санкт-Петербург

Kuznetsova Daria A., PhD Med, physician of clinical laboratory diagnostics at Laboratory Diagnostics of Autoimmune Diseases of National Medical Center ofMolecular Medicine

Saint Petersburg

lariwar@mail.ruhttps://orcid.org/0000-0002-4998-3699ЛапинС. В.LapinS. V.

Лапин Сергей Владимирович, к. м. н., зав. лабораторией диагностики аутоиммунных заболеваний НМЦ молекулярной медицины Минздрава России

Санкт-Петербург

Lapin Sergey V., PhD Med, head of Laboratory Diagnostics of Autoimmune Diseases of National Medical Center of Molecular Medicine

Saint Petersburg

svlapin@mail.ruhttps://orcid.org/0000-0001-8402-0743ЩукинаО. Б.ShchukinaO. B.

Щукина Оксана Борисовна, д. м. н., доцент, руководитель Городского центра диагностики и лечения воспалительных заболеваний кишечника, доцент кафедры общей врачебной практики (семейной медицины)

Санкт-Петербург

Shchukina Oksana B., DM Sci (habil.), associate professor, Head of the Municipal Center for Diagnostics and Treatment of Inflammatory Bowel Diseases, associate professor at Dept of General Medical Practice (Family Medicine)

Saint Petersburg

burmao@gmail.comhttps://orcid.org/0000-0002-6302-7767ГубонинаИ. В.GuboninaI. V.

Губонина Ирина Владимировна, к. м. н., доцент 2-й кафедры терапии (усовершенствования врачей)

Санкт-Петербург

Gubonina Irina V., PhD Med, associate professor at Dept of Therapy № 2 (Postgraduate Training)2

Saint Petersburg

giv70@bk.ruhttps://orcid.org/0000-0002-8432-9182КаманинА. А.KamaninА. А.

Каманин Алексей Александрович, к. м. н., ассистент кафедры общей хирургии с клиникой, врач хирургического отделения № 3 НИИ хирургии и неотложной медицины

Санкт-Петербург

Kamanin Aleksey A., PhD Med, assistant at Dept of General Surgery with a Clinic, physician (surgery) at Surgical Dept № 3 of the Research Institute of Surgery and Emergency Medicine

Saint Petersburg

alexkamanin@yandex.ruhttps://orcid.org/0000-0002-5524-1616ДавыдовД. А.DavydovD. A.

Давыдов Денис Андреевич, аспирант кафедры госпитальной терапии с курсом аллергологии и иммунологии им. акад. М. В. Черноруцкого с клиникой

Санкт-Петербург

Davydov Denis A., postgraduate student at Dept of Hospital Therapy with a Course in Allergology and Immunology named after Academician M. V. Chernorutsky with a Clinic

Saint Petersburg

davydov.rheum@gmail.comhttps://orcid.org/0000-0002-2079-0439ЭмануэльВ. Л.EmanuelV. L.

Эмануэль Владимир Леонидович, д. м. н. профессор, заведующий кафедрой клинической лабораторной диагностики с курсом молекулярной медицины

Санкт-Петербург

Emanuel Vladimir L., DM Sci (habil.), professor, head of Dept of Clinical Laboratory Diagnostics with a Course in Molecular Medicine

Saint Petersburg

vladimirem1@gmail.comФГБОУ ВО «Первый Санкт-Петербургский государственный медицинский университет имени академика И. П. Павлова» Минздрава РоссииРоссияPavlov First Saint Petersburg State Medical University (Pavlov University)Russian FederationФГБОУ ВО «Военно-медицинская академия им. С. М. Кирова» Министерства обороны РоссииРоссияMilitary Medical Academy named after S. M. KirovRussian Federation20252403202505«Современная лаборатория» (1)2633Copyright © Кузнецова Д.А., Лапин С.В., Щукина О.Б., Губонина И.В., Каманин А.А., Давыдов Д.А., Эмануэль В.Л., 20252025Кузнецова Д.А., Лапин С.В., Щукина О.Б., Губонина И.В., Каманин А.А., Давыдов Д.А., Эмануэль В.Л.Kuznetsova D.A., Lapin S.V., Shchukina O.B., Gubonina I.V., Kamanin А.А., Davydov D.A., Emanuel V.L.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-alphabet.com/jour/article/view/4238Актуальность

Актуальность: серологическое профилирование воспалительных заболеваний кишечника (ВЗК) с использованием аутоантител представляет собой дополнительный неинвазивный инструмент дифференциальной диагностики и индивидуального прогнозирования клинического течения болезни Крона (БК) и язвенного колита (ЯК).

Цель

Цель: определить частоту, диагностическую и прогностическую значимость панкреатических аутоантител (pancreatic autoantibodies, PAB), аутоантител к гликопротеину 2 (glycoprotein 2, GP2) и бокаловидным клеткам кишечника (goblet cells antibodies, GAB) в оценке клинических исходов БК и ЯК.

Материал и методы

Материал и методы: в исследование было включено 117 пациентов с БК, 45 – ЯК и 24 – неклассифицируемым колитом (НК). Группу сравнения составили 36 пациентов с другими заболеваниями ЖКТ (синдром раздраженного кишечника с диареей (СРК-Д), целиакия, аутоиммунный гастрит (АИГ)), контрольную группу – 29 условно здоровых лиц. Измерение содержания PAB и GAB класса IgG проводилось методом нРИФ (EUROIMMUN AG, Германия), GP2 классов IgA и IgG и фекального кальпротектина (ФК) – методом ИФА (Generic Assays GmbH, Германия, BÜHLMANN Laboratories AG, Швейцария).

Результаты

Результаты: частота обнаружения PAB класса IgG, GP2 класса IgA и GP2 класса IgG у пациентов с БК составила 25,6%, 24% и 12% соответственно, что достоверно выше по сравнению с пациентами с ЯК (6,6%, 15,5% и 4,4%), НК (4,1%,12,5% и 0%), АИГ (5,2%, 0% и 5,2%), СРК-Д (0%, 0% и 0%) и контрольной группой (6,9%, 3,4% и 6,9%) (р<0,05), тогда как не отличалась от пациентов с целиакией (9%, 18,2% и 9%). Комбинированное определение PAB IgG+ и/или GP2 IgA+/G+ обладает наибольшей предсказательной ценностью в дифференциальной диагностике БК с ЯК с использованием порога детекции GP2 IgG в значении ≥ 5,0 ЕД/мл (диагностическая чувствительность (ДЧ) – 47%, диагностическая специфичность (ДС) – 87%, AUC (95% ДИ): 0,64 (0,55–0,73), p<0,05). Серопозитивность по панкреатическим аутоантителам прямо коррелирует с уровнем ФК при БК, а также служит неблагоприятным прогностическим маркером тяжелой степени обострения, осложненной формы и потребности в хирургическом лечении БК. Встречаемость GAB класса IgG у пациентов с БК составила 21,3% vs. с ЯК – 35,5% (р=0,2), НК – 25% (р=0,9) и целиакией – 9% (р=0,4), тогда как была серонегативна у пациентов с СРК-Д, АИГ и контрольной группы. Определение GAB класса IgG обладает хорошей предсказательной ценностью в диагностике ЯК, особенно в сочетании с серонегативным результатом определения панкреатических аутоантител (ДЧ – 32% и ДС – 91,1% (AUC (95%ДИ) = 0,62 (0,54–0,69), p=0,002), а также может служить дополнительным маркером терминального илеита и необходимости оперативного лечения БК.

Заключение

Заключение: серологическое обследование ВЗК с сочетанным определением PAB класса IgG, GP2 класса IgА, GP2 класса IgG и GAB класса IgG позволяет повысить эффективность дифференциальной диагностики и прогнозирования индивидуального течения БК и ЯК.

Background

Background: serological profiling of inflammatory bowel diseases (IBD) using autoantibodies represents an additional non-invasive tool for differential diagnosis and prognosis of the clinical course of Crohn’s disease (CD) and ulcerative colitis (UC).

Aim

Aim: to determine the frequency, diagnostic and prognostic significance of pancreatic autoantibodies (PAB), autoantibodies to glycoprotein 2 (GP2) and intestinal goblet cells antibodies (GAB) in assessing the clinical outcomes of CD and UC.

Materials and methods

Materials and methods: the study included 117 patients with CD, 45 with UC and 24 with IBD unclassified (IBDU). The comparison group consisted of 36 patients with other gastrointestinal diseases (irritable bowel syndrome with diarrhea (IBS-D), celiac disease, autoimmune gastritis (AIH)), the control group consisted of 29 conditionally healthy individuals. The content of PAB and GAB class IgG was measured by the IIF method (EUROIMMUN AG, Germany), GP2 classes IgA and IgG and fecal calprotectin (FCP) – by the ELISA method (Generic Assays GmbH, Germany, BÜHLMANN Laboratories AG, Switzerland).

Results

Results: the frequency of PAB IgG, GP2 IgA and GP2 IgG in patients with CD was 25.6%, 24% and 12%, respectively, which was significantly higher compared to patients with UC (6.6%, 15.5% and 4.4%), IBDU (4.1%, 12.5% and 0%), AIH (5.2%, 0% and 5.2%), IBS-D (0%, 0% and 0%) and the control group (6.9%, 3.4% and 6.9%) (p<0.05), while it did not differ from patients with celiac disease (9%, 18.2% and 9%). Combined determination of PAB IgG+ and/or GP2 IgA+/G+ has the highest predictive value in the differential diagnosis of CD from UC using the cutt-off value of GP2 IgG at ≥5.0 U/ml (sensitivity – 47%, specificity – 87%, AUC (95% CI): 0.64 (0.55–0.73), p<0.05). Seropositivity for PABs correlates with the level of FCP in CD, and also serves as an unfavorable prognostic marker of severe exacerbation, complicated form and the need for surgical treatment of CD. The incidence of GAB IgG in patients with CD was 21.3% vs. with UC – 35.5% (p = 0.2), IBDU – 25% (p = 0.9) and celiac disease – 9% (p = 0.4), while it was seronegative in patients with IBS-D, AIH and the control group. Determination of GAB IgG has a good predictive value in the diagnosis of UC, especially in combination with a seronegative result of determining PABs (sensitivity – 32%, specificity – 91.1% (AUC (95% CI) = 0.62 (0.54–0.69), p = 0.002), and can also serve as an additional marker of terminal ileitis and the need for surgical treatment of CD.

Conclusion

Conclusion: serological examination of IBD with combined determination of PAB IgG, GP2 IgA, GP2 IgG and GAB IgG allows to increase the efficiency of differential diagnostics and prediction of individual course of CD and UC.

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