粪钙卫蛋白含量和结肠炎活动性之间的关系及临床应用价值

The Correlation of the Contents of Fecal Calprotectin and the Activity of Colitis in Ulcerative Colitis and its Value as an Indicator of Disease Activity

目的探讨溃疡性结肠炎(UC)患者粪钙卫蛋白含量(Fecal calprotectin content,FCC)和结肠活动性之间的关系,以明确粪钙卫蛋白作为炎症性肠病诊断标志物的临床价值。方法肠镜确诊的UC患者45例,肠镜前/后留取5g粪便用ELISA测定FCC;并检ESR和CRP。炎症活动性根据内镜和病理学标准判断。肠镜正常的18例门诊病例作为对照。结果活动期UC组FCC(578.5μg/g)显著高于缓解期(10.84μg/g,P<0.01)和正常对照(4.94μg/g,P<0.01),后两者之间差异无统计学意义(P>0.05);缓解期与活动期各级(I、Ⅱ、Ⅲ期)差异有统计学意义(P<0.01);FCC与活动期UC内镜分级显著相关(r=0.965,P<0.01),CRP和ESR与内镜分级的相关系数低于FCC。结论 FCC与内镜分级标准具有较好的相关性,可客观反映UC的炎症活动情况,比血清学指标ESR和CRP更敏感和特异;而且是一种方便无创的检查方法,可以弥补内镜检查痛苦大、价格高、不宜反复检查的不足,具有临床推广价值。

Objective To evaluate the correlation of the contents of fecal calprotectin and activity of colitis in ulcerative colitis,and evaluate the accuracy of fecal calprotectin as a non-invasive indicator of disease activity.The references are erythroeyte sedimentation rate（ESR）and C-reactive protein（CRP）.Methods 18 healthy persons as control and 45 patients with UC were recruited after colonoscopy.All were asked to collect 5g of stool sample for determining fecal calprotectin by an enzyme—linked immunosorbent assay.The disease activity of UC was evaluated according to colonoscopic and histological criteria.CRP,ESR were also measured.Results The fecal calprotectin concentration among patients with active UC（578.5ug/g）was significantly higher than that of inactive UC group（10.84 ug/g,P0.01）and healthy controls（4.94 ug/g,P0.01）.The difference between control group and inactive group was not statistically significant（P0.05）.Significant difference existed between each active grades（I,Ⅱ,Ⅲ）and inactive phase of UC（P0.01）.There has a significant correlation between endoscopic grades of disease activity and fecal calprotectin concentration（r=0.965,P0.01）.The correlation coefficient between CRP/ESR and histological grades were 0.952（P0.01）and 0.948（P0.01）respectively.Both were lower than that of calprotectin.Conclusion Fecal calprotectin levels reflect the disease activity in UC and can be used to monitor the response to treatment and detect relapses.It was an objective,simple and noninvasive measurement and was better than ESR and serum CRP.