粪便钙卫蛋白及髓过氧化物酶在评估溃疡性结肠炎活动性的应用

Application of fecal calprotectin and myeloperoxidase in evaluation of disease activity of ulcerative colitis

目的探讨粪钙卫蛋白、髓过氧化物酶评估溃疡性结肠炎疾病活动性的应用价值。方法本研究属于横断面研究。选取2010年1月到2012年4月就诊于北京大学第一医院消化内科的溃疡性结肠炎（uc）患者49例，男32例，女17例，中位年龄40岁（13～80岁），留取患者血及粪便标本，同时搜集患者临床资料，采用Mayo评分系统将UC患者分为缓解期组（22例）和活动期组（27例），其中活动期组分为轻、中、重度3组（分别为6、9、12例）。选取无消化道症状、便常规及便潜血检查均阴性，经内镜检查排除UC诊断，排除有严重心、肺、肾脏疾患的健康体检者作为对照组，男23例，女12例，中位年龄43岁（24～75岁），留取其血清及粪便。采用ELISA检测两组粪提取液中钙卫蛋白、髓过氧化物酶含量。将各组中粪钙卫蛋白、髓过氧化物酶、ESR及血清C反应蛋白（CRP）分别进行比较，同时将其与Baron内镜分级、Mayo临床活动指数进行相关性分析，并绘制ROC曲线。结果UC活动期组粪钙卫蛋白含量显著高于缓解期组[6000．0（3050．8，8759．5）VS336．8（227．5，1731．0），Z=-3．357，P=0．001]，缓解期组显著高于对照组[336．8（227．5，1731．0）VS 29．0（21．3，48．8），Z=-5．607，P=0．001]；UC活动期组粪便髓过氧化物酶含量显著高于缓解期组[1231．2（757．9，1481．1）VS603．6（265．2，819．4），z=-3．658，P=0．001]，缓解期组高于对照组[603．6（265．2，819．4）VS 453．5（140．8，750．2），Z=-1．033，P=0．302]；粪钙卫蛋白在轻度与中度活动组相比差异有统计学意义[5302．3（1140．5，9531．0）VS 5696．8（5510．0，7593．0），Z：-0．236，P=0．918]，在中度与重度活动组相比差异有统计学意义[5696．8（5510．0，7593．0）VS．6000（4284．0，9793．0），Z=-0．924，P=0．382]；粪髓过氧化物酶在轻度与中度活动组相比差异有统计学意义[667．3（467．5，1000．4）VS1259．6（1213．3，1932．8），Z=-2．475，P=0．005]，在中度与重度活动组相比差异有统计学意义[1259．6（1213．3，1932．8）VS1239．0（793．9，1403．0），Z=-1．350，P=0．193]。粪钙卫蛋白、粪髓过氧化物酶、ESR、血清CRP的测定值与Baron内镜分级相关系数分别为：R=0．382、0．499、0．359、0．246，相应P值分别为：P=0．007、0．001、0．010、0．093；与Mayo评分相关系数分别为：R：0．476、0．515、0．347、0．365，相应P值分别为：P=0．001、0．001、0．020、0．011。结论粪钙卫蛋白、髓过氧化物酶作为无创的生物标记物，在监测UC患者疾病活动性方面与指南中作为Mayo活动性评分组成的ESR、血CRP一样，与UC活动性均呈较好的相关性，粪钙卫蛋白在区分缓解期UC与对照组方面优于粪髓过氧化物酶。r中华捡验医学杂志，2013，36：348-351）

Objective To explore the clinical value of fecal calproteetin and myeloperoxidase in evaluation of ulcerative colitis （ UC ） activity. Methods Specimens of serum and feces over the same periodwere collected from 49 ulcerative colitis （ UC ） patients （32 male and 17 female） and 35 healthy controls （23 male and 12 female）. ELISA was used to measure the concentration of calprotectin and myeloperoxidase in feces. The clinical information （including Mayo clinic activity index. Baron endoscopic score ） of UC patients were collected. All patients were divided into active and inactive group by Mayo clinic activity index, the active group was further divided into three subgroups, the mild group, the moderate group and the severe group. Fecal ealprotectin and myeloperoxidase, serum ESR and CRP were compared among different groups, receiver operating curve （ ROC ） were obtained to evaluate the diagnostic efficacy of the UC activity. Results The fecal calprotectin concentration was significantly higher in active UC group than that in inactive UC group [6000. 0（3050. 8,8759. 5） vs. 336. 8（227.5,1731.0）, Z = -3. 357, P =0. 001 ] , the same to inactive UC group and the controls[336.8（227.5,1731.0）vs. 29.0（21.3,48.8）,Z= -5.607,P=0.001].The fecal myeloperoxidase concentration of the active UC group was significantly higher than that of the inactive UC group[ 1231.2（757.9,1481.1 ） vs. 603.6（265.2,819.4） ,Z = -3. 658 ,P =0. 001 ] , but there was no significant difference between the inactive UC group and the controls [ 603.6 （ 265.2,819.4 ） vs. 453.5 （ 140. 8,750. 2 ） , Z = - 1. 033, P = 0. 302 ]. There was no significant difference of fecal calprotectin levels among different active subgroups. Fecal myeloperoxidasc concentration between the mild activity group and the moderate activity group was significant [ 667.3 （467. 5,1000. 4） vs. 1259.6 （ 1213.3,1932. 8 ）, Z = - 2. 475,P = 0. 005 ], but there was no significant difference between the moderate activity group and the severe activity group [ 1259. 6 （ 1213.3,1932. 8 ） vs. 1239. 0 （ 793.9,1403.0 ）, Z =- 1. 350,P = 0. 193 ]. The four biomarkers were all positively correlated with the endoscopic score and Mayo clinic activity index of UC. Conclusions Considered as noninvasive biomarkers of disease activity fecal calprotectin and myeloperoxidase is similar to ESR and serum CRP. Fecal calprotectin is superior to myeloperoxidase in differentiating the inactive UC group from the controls. （Chin J Lab Med,2013,36：348-351 ）