| AimsTo elucidate the differences between ulcerative colitis(UC) and infectious colitis(IC) on clinical, endoscopical, microbiological, histological features and immunopathological manifestations. To supply comprehensive quantitative data for differentiating UC and IC, and establish a score system based on the measuring these features for the differentiating purpose. Methods1. The clinical, laboratory features in 127 patients of UC and 143 patients of IC diaglosed in West China hospital, Sichuan University from 1996 to 2001 were compared. The colonoscopical and histological features in 46 UC patients and 42 IC patients from 1999 to 2001 were compared and prospectively analysed, and molecular immunological markers were studied and compared in this group. ANCA was detected by indirect immunofluorescence technique(IIF) and ELISA with different target antigens.Expression of CD44v3,CD44v6,TGF P 1 on colonic mucosa was detected by immunohistochemistry(IHC). TGF {3 ImRNA expressing cells were detected by in situ hybridization(ISH).2. Referencing the method of score system to differentiate UC from CD by Organization Mondial de Gastroeneterology (OMGE), a score system to differentiate UC and IC was established. The cut off value to differentiate UC from IC was decided by receiver operator characteristic curve (ROC). ROC area , Youden index, sensitivity, specificity of these score systems were calculated.3. Differences were measured using t tests in numerical variable, Pearson X2 in categorical variable, with Fisher's Exact Test used in cases of small numbers and Wilcoxon test in rank data. All tests were two-tailed. P values of <0.05 were considered significant difference.Results1. There were significant differences in clinical and laboratory parameters such as clinical course, mode of onset, bloody and pus stools, precipitating factors, abdominal pain, vomiting, fever , white blood count and hemoglobin between two groups (P<0.001). ROC area , Youden index, sensitivity, specificity of clinical score (including library investigation) was 0.990, 0.903, 94.5%, 95.8%,respectively.2. Significant endoscopical findings in favour of UC consisted of diffuse distribution, granularity, spontaneous bleeding, blunted vesica, pseudopolyps. Patchy distribution was suggestive for IC. There was no difference in mucosal edema, erythema, erosion, ulcer and mucopurulentexudate between two groups(P>0.05). the sensitivity and specificity of diagnosing UC by colonoscopy was 95.7%, 97.6%.3. There were several histological features indicative of UC, including diffusely mixed or chronic inflammatory infiltration in lamina propria, crypt distorted and branched, crypt atrophy, villiform surface, basal plasmacytosis, etc. ROC area, Youden index, sensitivity, specificity of histological score was 0.978, 0.864, 93.5%, 92.9% respectively.4. ROC area, Youden index, sensitivity, specificity of clinical and endoscopical score was 0.997, 0.954, 97.8%, 97.6% respectively. The same index of clinical, endoscopical and histological score was 0.999, 0.976, 100%, 97.6% respectively.5. ANCA was found in 13 of the 27 UC patients (48.1%)by IIP, and 9 cases (33.3%) positively by ELISA. No expression of ANCA was found in IC patients. There was significant difference between two groups (p<0.05).6. Expression of CD44v3 and CD44v6 on colonic mucosa was 68.8%(22/32),56.3%(18/32) in UC patients respectively, but no expression in 30 IC patients with significant difference between two groups(p<0.05). There was no difference in detecting TGF 0 1 and TGF P ImRNA on colonic mucosa between two groups(p>0.05).There was correlation between expression of TGF P 1 and UC histological grade(r=0.462, P=0.002). ConclusionsThe score system based on clinical, laboratory, endoscopical, histological features of UC and IC patients has good value in differentiation of UC and IC. The sensitivities of the detection of ANCA ,CD44v3 and v6 in the diagnosis of UC were moderate, but their specificities w...
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