血清核周型抗中性粒细胞胞质抗体和粪钙卫蛋白对儿童溃疡性结肠炎病情预测的价值

Clinical significance of the serum perinuclear antineutrophil cytoplasmic antibody and fecal calprotectin in prediction the severity of ulcerative colitis in children

目的探讨血清核周型抗中性粒细胞胞质抗体(p-ANCA)和粪钙卫蛋白对儿童溃疡性结肠炎(UC)病情预测的价值。方法入选2014年3月至2019年3月湖北医药学院附属东风医院UC患儿100例,按照溃疡性结肠炎内镜严重程度指数(UCEIS)进行分组,缓解期29例;活动期71例,其中轻中度43例,重度28例。检测患儿血清白细胞介素-6(IL-6)、降钙素原(PCT)、C-反应蛋白(CRP)、红细胞沉降率(ESR)、白蛋白、血小板、血红蛋白、白细胞和p-ANCA,并检测粪钙卫蛋白。利用受试者工作特征(ROC)曲线评价各临床指标对活动期和重度UC的预测价值。结果缓解期患儿病程、IL-6、PCT、CRP、ESR、p-ANCA和钙卫蛋白均明显低于活动期患儿[(3.14±1.25)年比(3.73±0.89)年、(10.08±4.40)μg/L比(15.84±3.22)μg/L、(1.02±0.38)μg/L比(1.38±0.43)μg/L、(15.92±6.13)mg/L比(24.30±6.06)mg/L、(14.75±6.42)mm/1 h比(25.31±6.98)mm/1 h、(17.19±4.76)U比(28.01±6.12)U和(504.82±127.46)μg/g比(717.04±142.30)μg/g],差异有统计学意义(P<0.05或<0.01)。轻中度患儿IL-6、CRP、ESR、白细胞、p-ANCA和钙卫蛋白均明显低于重度患儿[(14.56±2.72)μg/L比(17.82±2.93)μg/L、(22.01±5.32)mg/L比(27.83±5.46)mg/L、(22.31±4.46)mm/1 h比(29.91±7.70)mm/1 h、(7.33±1.33)×10^9/L比(8.38±1.90)×10^9/L、(25.52±5.22)U比(31.83±5.44)U和(632.80±82.51)μg/g比(846.42±11.10)μg/g],差异有统计学意义(P<0.01或<0.05)。Pearson相关分析结果显示,活动期UC患儿UCEIS与钙卫蛋白呈高度相关(r=0.707,P<0.01),与p-ANCA、ESR、IL-6、CRP、白蛋白呈中度相关(r=0.660、0.650、0.626、0.592、0.486,P<0.01),与PCT、白细胞呈低度相关(r=0.362、0.245,P<0.01或<0.05)。ROC曲线分析结果显示,当p-ANCA最佳界值为23.40 U时,诊断活动期UC患儿的曲线下面积(AUC)最高(0.923),特异度为93.1%,敏感度为78.9%。当粪钙卫蛋白最佳界值为732.69μg/g时,诊断重度UC患儿的AUC最高(0.937),特异度为93.0%,敏感度为92.9%。结论血清p-ANCA可以作为UC患儿疾病活动的诊断指标,粪钙卫蛋白可以作为预测UC病情加重的指标。

Objective To investigate the clinical value of perinuclear antineutrophil cytoplasmic antibody(p-ANCA)and fecal calprotectin in predicting the severity of ulcerative colitis(UC)in children.Methods One hundred children with UC from March 2014 to March 2019 in Affiliated Dongfeng Hospital,Hubei University of Medicine were selected.According to the endoscopic severity index of ulcerative colitis(UCEIS),the children were divided into remission stage(29 cases);active stage(71 cases),among whom 43 cases were mild-moderate,and 28 cases were severe.The serum levels of interleukin-6(IL-6),procalcitonin(PCT),C-reactive protein(CRP),erythrocyte sedimentation rate(ESR),albumin,platelet,hemoglobin,white blood cell and p-ANCA were detected,and the fecal calprotectin was detected.The clinical value of each index in predicting the severity of UC was determined by receiver operating characteristic(ROC)curve.Results The course of disease,IL-6,PCT,CRP,ESR,p-ANCA and calprotectin in remission stage children were significantly lower than those in active stage children:(3.14±1.25)years vs.(3.73±0.89)years,(10.08±4.40)μg/L vs.(15.84±3.22)μg/L,(1.02±0.38)μg/L vs.(1.38±0.43)μg/L,(15.92±6.13)mg/L vs.(24.30±6.06)mg/L,(14.75±6.42)mm/1 h vs.(25.31±6.98)mm/1 h,(17.19±4.76)U vs.(28.01±6.12)U and(504.82±127.46)μg/g vs.(717.04±142.30)μg/g,and there were statistical differences(P<0.05 or<0.01).The IL-6,CRP,ESR,white blood cell,p-ANCA and calprotectin in mild-moderate children were significantly lower than those in sever children:(14.56±2.72)μg/L vs.(17.82±2.93)μg/L,(22.01±5.32)mg/L vs.(27.83±5.46)mg/L,(22.31±4.46)mm/1 h vs.(29.91±7.70)mm/1 h,(7.33±1.33)×10^9/L vs.(8.38±1.90)×10^9/L,(25.52±5.22)U vs.(31.83±5.44)U and(632.80±82.51)μg/g vs.(846.42±11.10)μg/g,and there were statistical differences(P<0.01 or<0.05).Pearson correlation analysis result showed that,in active children,the UCEIS had high positive correlation with fecal calprotectin(r=0.707,P<0.01),mild positive correlation with p-ANCA,ESR,IL-6,CRP and albumin(r=0.660,0.650,0.626,0.592 and 0.486;P<0.01),and low positive correlation with PCT and white blood cell(r=0.362 and 0.245,P<0.01 or<0.05).ROC curve analysis result showed that the optimal cut-off value of p-ANCA was 23.40 U,and the area under curve(AUC)in diagnosis of active stage UC was maximum(0.923),with a specificity of 93.1%and a sensitivity of 78.9%;the optimal cut-off value of fecal calprotectin was 732.69μg/g,and the AUC in diagnosis of active stage UC was maximum(0.937),with a specificity of 93.0%and a sensitivity of 92.9%.Conclusions Serum p-ANCA is useful for UC disease activity diagnosis in children,while fecal calprotectin is independent predictor of the severe of UC.