血清胆碱酯酶评估炎症性肠病活动度的价值分析

Role of serum cholinesterase in evaluating disease activity of patients with inflammatory bowel disease

目的分析血清胆碱酯酶(cholinesterase,ChE)水平对评估炎症性肠病(inflammatory bowel disease,IBD)活动度的临床价值。方法选取2016年2月至2018年2月武汉大学人民医院消化内科诊治为IBD患者151例,其中克罗恩病(CD亚组)患者57例、溃疡性结肠炎(UC亚组)患者94例,另选取本院同期健康体检者150名作为对照组,分析血清ChE与IBD的关系,并用ROC曲线评估诊断IBD的价值。结果各组间血清ChE比较:IBD组、UC亚组及CD亚组均低于对照组(F=3.9、1.5、5.5,t=12.0、10.9、8.0,P均<0.0001);CD患者血清ChE与hsCRP(r=-0.44,P=0.001)、CDAI(r=-0.48,P=0.0002)、PLT(r=-0.37,P=0.005)均呈负相关; UC患者血清ChE与hsCRP(r=-0.54,P<0.0001)、ESR(r=-0.35,P=0.0005)、Mayo评分(r=-0.67,P<0.0001)均呈负相关,与HCT呈正相关(r=0.61,P<0.0001)。ChE水平诊断IBD的曲线下面积(AUC)为0.841,诊断中、重度CD、UC的AUC分别为0.797、0.814。结论血清ChE水平对评估IBD患者疾病活动度方面具有一定的临床价值与意义。

Objective To investigate the clinical value of serum cholinesterase (ChE) as an indicator for evaluating inflammatory bowel disease (IBD) activity. Methods This study adopted the case-control method, in which case group included 57 cases diagnosed as CD patients and 94 patients with UC, and the control group included 150 healthy physical examination, collected from Feb. 2016 to Feb. 2018 in Renmin Hospital of Wuhan University. Correlation of serum ChE with clinical features of IBD was anayzed. The accuracy of diagnosis was analyzed by receiver operating characteristic ( ROC ) analysis. Results The level of serum ChE in IBD group was significantly lower than that in healthy control group, both with UC subgroup and CD subgroup ( F=3.9, 1.5, 5.5, t =12.0, 10.9, 8.0, all P <0.0001). The level of serum ChE in CD subgroup was negatively correlated with hsCRP ( r=-0.44, P =0.001), PLT ( r =-0.37, P = 0.005 ) and CDAI ( r=-0.48, P = 0.0002), meainwhile, the level of serum ChE in UC group was negatively correlated with hsCRP ( r=-0.54, P <0.0001), ESR ( r=-0.35, P = 0.0005 ), Mayo score ( r=-0.67, P <0.0001), but inversely with HCT levels ( r=0.61 , P <0.0001). The level of serum ChE predicted the area under the ROC curve ( AUC ) of IBD was 0.841. The level of serum ChE predicted the AUC of CD and UC moderate and severe activity group was 0.797, 0.814 . Conclusion Serum ChE level has certain clinical value and significance in diagnosing and evaluating the disease activity of IBD patients.