非侵入性分子标志物评估临床缓解期炎症性肠病内镜活动度价值研究

Accuracy of noninvasive biomarkers in detecting active mucosal inflammation in IBD patients in clinical remission

目的评估非侵入性分子标志物在临床缓解期炎症性肠病（IBD）患者内镜活动度判断中的效能。方法选择2014年8月至2015年2月在南方医院消化内镜中心行电子结肠镜检查的已确诊临床缓解期结肠或回结肠型克罗恩病（CD）34例，溃疡性结肠炎（UC）25例，均于结肠镜检查前1-3d留取粪便，检测粪便钙卫蛋白（FC）浓度，并搜集血标本检测C反应蛋白（CRP）、红细胞沉降率（ESR）及降钙素原（PCT）浓度。结肠或回结肠型CD及UC患者内镜活动度评估分别采用简单克罗恩病内镜评分（SES—CD）和Mayo评分。结果34例临床缓解结肠或回结肠型CD中，FC与SESCD相关性最高（r=0．730），FC在临界值250μg／g时，预测内镜活动度的敏感度和特异度分别为93％和70％。25例UC中，FC与Mayo评分相关性最高（r=0．825），FC在临界值250μg／g时，预测内镜活动度的敏感度和特异度分别为84．6％和100．0％。结论FC能更有效发现临床缓解期IBD内镜下的活动性炎症。

Objective To evaluate the efficacy of noninvasive biomarkers in detecting active mucosal inflammation in inflammatory bowel disease （IBD） patients in clinical remission. Methods We recruited the patients with confirmed diagnosis of colonic or ileo-colonic Crohffs disease（CD） ancl Ulcerative colitis（UC） in clinical remission. Fecal samples were collected from 3 days to 1 day before bowel preparation, and fecal calprotectin（FC） was measured by ELISA kit. Before endoscopy examinations, all patients were taken a blood sample to measure CRP, ESR and procalcitonin（PCT） level. Endoscopic activity was determined for colonic or ileo-colonic CD with Simple Endoscopic Score for Crohn＇s Disease （SES-CD） and UC with the Mayo score. Results For 34 patients with clinical remission colonic or ileo-colonic CD in clinical remission： the SES-CD was correlated more closely with levels of FC （r=-0.730）, and FC threshold of 250 μg/g had a sensitivity of 93.0% and a specificity of 70.0% in indicating active endoscopic disease. For 25 UC patients in dinical remission： the Mayo score was also correlated significantly with FC （r=0.825） and a cut-off value of 250 μg/g indicated endoscopic active inflammation with 84.6% sensitivity and 100.0% specificity. Conclusion FC is the most promising noninvasive biomarker than the others in detecting preclinical active endoscopic inflammation in IBD patients in clinical remission.