Диагностическая и прогностическая значимость серологических маркеров воспалительных заболеваний кишечника (обзор литературы)

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Диагностика воспалительных заболеваний кишечника (ВЗК) основана на комбинации клинических, эндоскопических, гистологических, лучевых и  лабораторных методов исследования. Однако традиционные методы не всегда обладают достаточной информативностью в диагностике ВЗК, особенно в случаях неклассифицируемого колита, что обусловливает необходимость расширения стандартных диагностических подходов. В  настоящее время активно ведется поиск неинвазивных серологических маркеров для ранней и дифференциальной диагностики ВЗК, а также оценки активности и  прогноза течения болезни Крона (БК) и  язвенного колита (ЯК). Среди показателей, вызывающих наибольший интерес, выделяют антитела к  Saccharomyces cerevisiae (англ. аntiSaccharomyces cerevisiae, ASCA), антинейтрофильные цитоплазматические антитела (англ. аntineutrophil cytoplasmic antibodies, ANCA), аутоантитела к  бокаловидным клеткам кишечника (англ. goblet cells antibodies, GAB) и  ацинарным клеткам поджелудочной железы (англ. pancreatic autoantibodies, PAB). Целью настоящего обзора стала оценка диагностической и  прогностической значимости ASCA, ANCA, GAB, PAB при БК и ЯК. В статье приведены обобщенные данные о  роли вышеуказанных антител в  нарушениях механизма иммунологической толерантности к  кишечной микрофлоре и  проницаемости кишечника при ВЗК. Обсуждаются результаты исследований ассоциаций ASCA с  осложненным фенотипом БК, ответом на генно-инженерную биологическую терапию, а  также необходимостью хирургических вмешательств. Представлены данные о связи ANCA с  риском прогрессирования левостороннего ЯК до распространенного (тотального) поражения толстой кишки, резистентного к  проведению гормональной терапии, а  антител к ДНК-лактоферриновым комплексам и протеиназе 3 – с первичным склерозирующим холангитом. Отмечено, что PAB могут выступать в качестве прогностического маркера илеоколита, перианальных поражений, внекишечных проявлений и  осложненного течения БК, а  GAB  – предиктора тотального ЯК с  хроническим постоянным течением. Подчеркивается высокая информативность комбинированного определения ASCA, ANCA, GAB и PAB по сравнению с изолированным выявлением аутоантител при проведении дифференциальной диагностики и прогнозирования БК и ЯК.

Об авторах

Д. А. Кузнецова

ФГБОУ ВО «Первый Санкт-Петербургский государственный медицинский университет имени академика И.П. Павлова» Минздрава России

Автор, ответственный за переписку.
Email: lariwar@mail.ru
ORCID iD: 0000-0001-5318-354X

Кузнецова Дарья Александровна – кандидат медицинских наук, врач клинической лабораторной диагностики лаборатории диагностики аутоиммунных заболеваний Научно-методического центра по молекулярной медицине

197022, г. Санкт-Петербург, ул. Льва Толстого, 6–8

Россия

С. В. Лапин

ФГБОУ ВО «Первый Санкт-Петербургский государственный медицинский университет имени академика И.П. Павлова» Минздрава России

Email: svlapin@mail.ru
ORCID iD: 0000-0002-4998-3699

Лапин Сергей Владимирович – кандидат медицинских наук, заведующий лабораторией диагностики аутоиммунных заболеваний Научно-методического центра по молекулярной медицине

197022, г. Санкт-Петербург, ул. Льва Толстого, 6–8

Россия

О. Б. Щукина

ФГБОУ ВО «Первый Санкт-Петербургский государственный медицинский университет имени академика И.П. Павлова» Минздрава России;
СПбГУЗ «Городская клиническая больница № 31»

Email: burmao@gmail.com

Щукина Оксана Борисовна – доктор медицинских наук, доцент кафедры общей врачебной практики (семейной медицины); руководитель Городского центра диагностики и лечения воспалительных заболеваний кишечника СПбГУЗ «Городская клиническая больница № 31»

197022, г. Санкт-Петербург, ул. Льва Толстого, 6–8; 
197110, г. СанктПетербург, пр-т Динамо, 3

Россия

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