粪便嗜酸粒细胞阳离子蛋白对溃疡性结肠炎活动性的评价价值

Significance of Fecal Eosinophil Cationic Protein in the Evaluation of Disease Activity in Ulcerative Colitis

目的探讨粪便嗜酸粒细胞阳离子蛋白(ECP)对溃疡性结肠炎(UC)活动性的评价价值。方法选择2010年1月—2012年4月北京大学第一医院消化内科确诊的UC患者45例为病例组,根据Mayo疾病活动指数(UCAI)、腹泻次数、便血情况、黏膜表现及医师对病情的评定,将患者分为缓解期组(19例)和活动期组(26例),活动期组根据UCAI将患者分为轻度活动5例,中度9例,重度12例;选择同期本院健康体检正常者30例为对照组。采用荧光酶免法定量检测各组粪便ECP水平,同时检测血清C-反应蛋白(CRP)水平和红细胞沉降率(ESR)。应用SPSS 13.0软件进行统计分析,绘制受试者工作特征(ROC)曲线并计算曲线下面积(AUC)及Youden's指数,评价各指标判断UC疾病活动性的诊断效能。结果各组粪便ECP水平比较,差异有统计学意义(P=0.000);其中活动期组粪便ECP水平高于缓解期组(P<0.05);缓解期组高于对照组(P<0.05)。各组CRP水平比较,差异有统计学意义(P=0.002);其中活动期组CRP水平高于缓解期组,但差异无统计学意义(P>0.05);缓解期组高于对照组(P<0.05)。各组ESR比较,差异有统计学意义(P=0.012);其中活动期组ESR高于缓解期组(P<0.05),缓解期组低于对照组,但差异无统计学意义(P>0.05)。不同活动度活动期UC患者粪便ECP水平比较,差异有统计学意义(P=0.012);其中轻度活动组与重度活动组比较,差异有统计学意义(P=0.002);轻度活动组与中度活动组、中度活动组与重度活动组比较,差异均无统计学意义(P值分别为0.019和0.095)。不同活动度活动期UC患者血清CRP水平及ESR比较,差异均无统计学意义(P>0.017)。Spearman相关分析显示,粪便ECP水平与UCAI呈正相关(r=0.809,P=0.000)。粪便ECP判断UC疾病活动性的AUC为0.939,血清CRP为0.578,ESR为0.721。当粪便ECP水平为52.41μg/g时,Youden's指数最高(1.779),即判断UC疾病活动性的诊断效能最好。结论粪便ECP与UCAI有很好的相关性,诊断效能优于血清CRP和ESR,有助于临床判断UC活动性,但对活动期患者活动度的判断价值有限;可作为一种简便、经济、准确、灵敏、无创的生物标记物用于监测UC活动性。

Objective To investigate the value of fecal eosinophil cationic protein （ECP） in the evaluation of the ac- tivity of ulcerative colitis （UC）. Methods 45 UC patients confirmed in the Department of Digestive System of the First Hospital of Peking University from January 2010 to April 2012 were selected as case group. The patients were divided into remission group （19 cases） and active group （26 cases） according to Mayo disease activity index （UCAI）, diarrhea times, hemafecia, mu- cous membrane condition and the doctor＇s assessment. Patients in active group were also divided into slightly active group （5 ca- ses）, moderately active group （9 cases） and severely active group （12 cases）. 30 healthy people who underwent physical ex- amination in the same period were selected as control group. Fluorescence enzyme - immunoassay method was used to quantita- tively detect the levels of ECP as well as C -reactive protein （CRP） and erythrocyte sedimentation rate （ESR） in each group. SPSS 13. 0 was used to make statistical analysis. Receiver Operating Characteristic （ROC） curve was drawn and the area of AUC and Youden＇s index were calculated. The diagnostic efficiency of each index for the evaluation of the UC activity was as- sessed. Results The levels of fecal ECP between each group showed statistically significant differences （ P = O. 000）. The level of fecal ECP in the active group was significantly higher than that of the remission group （ P 〈 0. 05 ） , and the level of the remis- sion group was significantly higher than that of the control group （ P 〈 0. 05 ）. The levels of serum CRP between each group also showed statistically significant differences （P = 0. 002 ）. The level of serum CRP in the active group was higher than that of the remission group without statistically significant difference （ P 〉 0. 05 ） , and the level of the remission group was significantly higher than that of the control group （ P 〈 0.05 ）. The levels of serum ESR between each group showed statistically significant differ- ences as well （P = 0. 012 ）. The level of serum ESR in the active group was significantly higher than that of the remission group （ P 〈 0. 05 ）, and the level of the remission group was higher than that of the control group without statistically significant differ- ence （ P 〉 0.05 ）. The ECP levels of the UC patients with different activity levels showed statistically significant differences （ P = 0. 012 ）, among which the slightly active group showed statistically significant difference compared with severely active group （P = 0. 002）, and the slightly active group showed no statistically significant differences compared with the moderately active group and the moderately active group also showed no statistically significant difference compared with the severely active group （P = 0. 019 and 0. 095）. The serum CRP and ESR levels between the UC patients with different activity levels both showed no statistically significant differences （P 〉 0. 017）. Spearman correlation analysis showed that fecal ECP was positively correlated with UCAI （ r = 0. 809, P = 0. 000 ）. The AUC of fecal ECP for judging the disease activity of UC was0. 939, while the AUC of the serum CRP and serum ESR was 0. 578 and 0. 721 respectively. When fecal ECP was 52.41 μg/g, the Youden＇s index was the highest 1. 779, namely the best diagnostic performance in judging UC activity. Conclusion Fecal ECP and UCAI are well connected and fecal ECP has better diagnostic efficacy than serum CRP and ESR. It is conducive to the judgment of UC activity in clinic, but has limited diagnostic value in judging the activity level of patients in active stage. Therefore, ECP can be regar- ded as a simple, economical, accurate, sensitive and noninvasive biomarker for the monitoring of UC patients＇activities.