克罗恩病病变部位对粪便钙卫蛋白水平的影响

Impact of disease location on fecal calprotectin in Crohn 's disease patients

目的本研究探讨克罗恩病(CD)对粪便钙卫蛋白(FC)水平的影响。方法纳入40例CD患者,行结肠镜检查、抽血及留取粪便标本检测FC水平。参照简化CD内镜评分(SES-CD)对5个肠段(回肠末端、右半结肠、横结肠、左半结肠、直肠)进行内镜评分,各节段中评分最高者为该患者的最高内镜评分(M-SESCD),依据M-SESCD分为无黏膜病变组、黏膜炎症组(轻、中、重度)。结果 40例CD患者共完成62次结肠镜检查、抽血及FC检测。黏膜炎症组患者超敏C反应蛋白(hs-CRP)含量3.4(0.5,21.9)mg/L显著高于无黏膜病变组患者0.5(0.5,1.8)mg/L,FC水平618(354,1636)mg/kg显著高于无黏膜病变组患者65(32,110)mg/kg,差异有统计学意义(P<0.05)。FC水平随黏膜病变严重程度增加而升高,亚组分析显示,中度黏膜病变患者中,回肠型FC水平显著低于(回)结肠型,差异有统计学意义(P<0.001)。结论 FC水平与CD内镜病变明显相关,并且可能受病变部位影响。

Objective The aim of this study is to evaluate the influence of disease location on fecal calprotectin in Crohn＇s disease（ CD） patients. Methods 40 CD patients scheduled to undergo colonoscopy and blood test were enrolled and fecal samples for FC measurement are collected prior to the procedure. Simplified endoscopic activity score for Crohn＇s disease（ SES-CD） is determined for each of 5 bowel segments（ including ileum,right colon,transverse colon,left colon and rectum）. The maximum score among 5 segments is defined as the maximum sore of SESCD（ M-SESCD）. According to the M-SESCD,all patients are grouped into non-mucosal disease and mucosal inflammatory disease（ mild, moderate and severe）. Results 62 complete colonoscopies,haemospasia and FC measurements were evaluated in 40 CD patients.Significant difference are seen in hypersensitive C-reactive protein [3.4（ 0. 5,21. 9） vs 0. 5（ 0. 5,1. 8）,P 0. 05] and FC levels [618（ 354,1636） vs 65（ 32,110）,P 0. 001]between patients with non-mucosal disease and patients with mucosal inflammatory disease. FC levels correlate well with endoscopic disease activity（ P 0. 001）. Subgroup analysis shows that among patients with moderate mucosal disease,the FC levels are significantly lower in ileal CD compared to colonic CD with（ ileo） [481.3（ 442.5,1102） vs 949.7（ 585.3,1982.2）,P 0.05]. Conclusions FC levels significantly correlated with endoscopic disease activity in CD. However, the sensitivity may be influenced by disease location.