粪便钙卫蛋白对溃疡性结肠炎病情活动的评估价值

The Value of Fecal Calprotectin in the Evaluation of the Disease Activity of Ulcerative Colitis

目的临床上Mayo评分及侵入性的肠镜检查是评估溃疡性结肠炎(UC)患者病情严重程度的重要方法。本文旨在探讨非侵入性指标粪便钙卫蛋白(FC)对判断UC临床及镜下病情活动程度的优势,并分析FC与Mayo评分及内镜下严重指数(UCEIS)的相关性。方法回顾性分析2018年3月至2019年6月在中国医科大学附属盛京医院第二消化内科经内镜及组织病理学确诊的100例UC患者资料,对Mayo评分≤2分且无单个分项评分>1分为临床缓解组,Mayo评分3~12分为临床活动组。对UCEIS 0~1分为镜下缓解组,UCEIS 2~8分为镜下活动组。绘制ROC曲线分析各项血液相关炎症指标(FC、WBC、PLT等)并对判断临床及镜下严重程度的预测效能,同时比较各指标与Mayo评分及UCEIS的相关性。结果 Mayo评分为临床活动组FC、WBC、PLT、CRP、ESR数值均显著高于临床缓解组,HB和ALB数值显著低于临床缓解组。镜下活动组FC、WBC、PLT、CRP、ESR数值均显著高于镜下缓解组,HB和ALB数值显著低于镜下缓解组,差异有统计学意义(P<0.01)。FC、WBC、PLT、CRP、ESR与临床严重程度及内镜下表现呈正相关,HB、ALB水平与临床严重程度及内镜下表现呈负相关,在各项血液相关炎症指标中,以FC的相关系数最高,临床严重程度及内镜下表现分别为r=0.899和r=0.528。FC>45.90μg/g时,能准确地评估UC患者目前处于临床活动期,其灵敏度、特异性、阳性预测值、阴性预测值分别为95.31%、97.22%、97.35%、95.04%。FC>39.17μg/g时,能准确地评估UC患者目前处于镜下活动期,其灵敏度、特异性、阳性预测值、阴性预测值分别为81.93%、94.12%、96.22%、74.06%。结论 FC是一种判断UC患者临床及镜下病情活动程度的较好评估指标。其可作为替代内镜检查对UC患者进行病情活动的评估。

Objective Clinically,Mayo score and invasive colonoscopy are important methods for assessing the severity of ulcerative colitis(UC)patients.This article aims to investigate the advantages of non-invasive index fecal calprotectin(FC)in determining the degree of clinical and microscopic disease activity in UC,and to analyze the correlation between FC and Mayo score and endoscopic index of severity(UCEIS).Methods A retrospective analysis of 100 cases of UC patients diagnosed by endoscopy and histopathology in the second digestive department of ShengJing Hospital affiliated to China Medical University from March,2019 to June,2019.Patients with scored ≤ 2 points for Mayo and no single score >1 were enrolled into the clinical remission group,and patients with Mayo score 3-12 were enrolled into the clinical activity group.UCEIS 0-1 patients were enrolled into the microscopic remission group,and UCEIS 2-8 patients were enrolled into the microscopic activity group.The ROC curve was used to analyze the blood-related inflammation indexes(FC,WBC,PLT,etc.)and to predict the clinical and microscopic severity.The correlations between each index and the Mayo score and UCEIS were compared.Results The values of FC,WBC,PLT,CRP and ESR in the Mayo score were significantly higher than those in the clinical remission group.The HB and ALB values were significantly lower than those in the clinical remission group.The values of FC,WBC,PLT,CRP and ESR in the active group were significantly higher than those in the microscopic remission group.The HB and ALB values were significantly lower than those in the microscopic remission group(P<0.001).FC,WBC,PLT,CRP and ESR were positively correlated with clinical severity and endoscopic performance.HB and ALB levels were negatively correlated with FC,and the correlation coefficient of FC was the highest,with r=0.899 and r=0.528,respectively.FC>45.90μg/g could accurately diagnose the clinical activity period of UC.The sensitivity,specificity,positive and negative predictive values were 95.31%,97.22%,97.35% and 95.04%,respectively.FC>39.17μg/g could accurately diagnose the active period of UC microscopy.The sensitivity,specificity,positive and negative predictive value were 81.93%,94.12%,96.22% and 74.06%,respectively.Conclusion FC is a good indicator for determing the severity of UC clinical and microscopic.FC can serve as a non-invasive alternative index for endoscopy UC disease monitoring.