粪便钙卫蛋白在炎症性肠病和功能性肠病鉴别诊断中的临床应用

Clinical application of fecal calprotectin in the differential diagnosis of inflammatory bowel disease and functional bowel disease

目的:探讨粪便钙卫蛋白(CPT)在炎症性肠病(IBD)及功能性肠病鉴别诊断中的应用价值。方法:选择2018年5—11月在南京医科大学第一附属医院初诊为IBD的住院患者221例,其中溃疡性结肠炎(UC)57例,克罗恩病(CD)164例;另选同期肠易激综合征(IBS)30例,正常对照120例。收集患者内镜检查前的粪便,采用酶联免疫吸附法(ELISA)检测各组粪便CPT水平。结果:CD与UC患者的粪便CPT水平均显著高于IBS组和对照组(P<0.001),而IBS组和对照组之间差异无统计学意义(P>0.05)。IBD患者中,UC组的粪便CPT含量显著高于CD组(P<0.05),且当按UC内镜下严重度指数及CD内镜活动评分分组时,UC轻度者的粪便CPT含量明显高于CD轻度者(P<0.05),UC中、重度者与CD中、重度者之间差异无统计学意义(P>0.05)。结论:粪便CPT水平可作为IBD活动性评估以及与IBS鉴别诊断的指标。

Objective: To investigate the clinical significance of calprotectin(CPT) in fecal in the differential diagnosis of inflammatory bowel disease(IBD) and other intestinal diseases. Methods: 221 inpatients with IBD who were newly diagnosed in the First Affiliated Hospital of Nanjing Medical University from May 2018 to Nov. 2018,including 57 cases of ulcerative colitis(UC) and 164 cases of Crohn’s disease(CD), another 30 cases of irritable bowel disease(IBS) and 120 cases of normal controls were enrolled. Feces before the endoscopy and that of the control group were collected and CPT was determined by enzyme-linked immunosorbent assay(ELISA) method. Results:The CPT level of CD and UC patients was significantly higher than that of IBS group and control group(P<0.001),but there was no significant difference between IBS group and control group(P>0.05). In IBD, CPT level in UC group was significantly higher than that of CD group(P<0.05), and when grouped according to the UC endoscopic index of severity and endoscopic activity score for CD, UC had significantly higher fecal CPT levels than CD in slight group(P<0.05), but showed no significant difference in moderate and severe group of UC compared with CD, respectively(P>0.05). Conclusions: Fecal CPT levels can be used as an effective indicator for evaluating IBD activity and differential diagnosis with IBS.