Utility of faecal calprotectin analysis in adult inflammatory bowel disease

The inflammatory bowel diseases (IBD), Crohn's disease and ulcerative colitis, are chronic relapsing, remitting disorders. Diagnosis, along with assessment of disease activity and prognosis present challenges to managing clinicians. Faecal biomarkers, such as faecal calprotectin, are a non-invasive method which can be used to aid these decisions. Calprotectin is a calcium and zinc binding protein found in the cytosol of human neutrophils and macrophages. It is released extracellularly in times of cell stress or damage and can be detected within faeces and thus can be used as a sensitive marker of intestinal inflammation. Faecal calprotectin has been shown to be useful in the diagnosis of IBD, correlates with mucosal disease activity and can help to predict response to treatment or relapse. With growing evidence supporting its use, over the last decade this faecal biomarker has significantly changed the way IBD is managed.

Faecal calprotectin and magnetic resonance imaging in detecting Crohn's disease endoscopic postoperative recurrence

AIM To assess magnetic resonance imaging(MRI) and faecal calprotectin to detect endoscopic postoperative recurrence in patients with Crohn's disease(CD).METHODS From two tertiary centers, all patients with CD who underwent ileocolonic resection were consecutively and prospectively included. All the patients underwent MRI and endoscopy within the first year after surgery or after the restoration of intestinal continuity [median = 6 mo(5.0-9.3)]. The stools were collected the day before the colonoscopy to evaluate faecal calprotectin level. Endoscopic postoperative recurrence(POR) was defined as Rutgeerts' index ≥ i2b. The MRI was analyzed independently by two radiologists blinded from clinical data.RESULTS Apparent diffusion coefficient(ADC) was lower in patients with endoscopic POR compared to those with no recurrence(2.03 ± 0.32 vs 2.27 ± 0.38 × 10^(-3) mm^2/s, P = 0.032). Clermont score(10.4 ± 5.8 vs 7.4 ± 4.5, P = 0.038) and relative contrast enhancement(RCE)(129.4% ± 62.8% vs 76.4% ± 32.6%, P = 0.007) were significantly associated with endoscopic POR contrary to the magnetic resonance index of activity(Ma RIA)(7.3 ± 4.5 vs 4.8 ± 3.7; P = 0.15) and MR scoring system(P = 0.056). ADC < 2.35 × 10^(-3) mm^2/s [sensitivity = 0.85, specificity = 0.65, positive predictive value(PPV) = 0.85, negative predictive value(NPV) = 0.65] and RCE > 100%(sensitivity = 0.75, specificity = 0.81, PPV = 0.75, NPV = 0.81) were the best cutoff values to identify endoscopic POR. Clermont score > 6.4(sensitivity = 0.61, specificity = 0.82, PPV = 0.73, NPV = 0.74), Ma RIA > 3.76(sensitivity = 0.61, specificity = 0.82, PPV = 0.73, NPV = 0.74) and a MR scoring system ≥ MR1(sensitivity = 0.54, specificity = 0.82, PPV = 0.70, and NPV = 0.70) demonstrated interesting performances to detect endoscopic POR. Faecal calprotectin values were significantly higher in patients with endoscopic POR(114 ± 54.5 μg/g vs 354.8 ± 432.5 μg/g; P = 0.0075). Faecal calprotectin > 100 μg/g demonstrated high performances to detect endoscopic POR(sensitivity = 0.67, specificity = 0.93, PPV = 0.89 and NPV = 0.77).CONCLUSION Faecal calprotectin and MRI are two reliable tools to detect endoscopic POR in patients with CD.

Faecal calprotectin: Management in inflammatory bowel disease

Inflammatory bowel disease(IBD) is a chronic and relapsing disorder which leads to an inflammation of the gastrointestinal tract. A tailored therapy to achieve mucosal healing with the less adverse events has become a key issue in the management of IBD. In the past, the clinical remission was the most important factor to consider for adapting diagnostic procedures and therapeutic strategies. However, there is no a good correlation between symptoms and intestinal lesions, so currently the goals of treatment are to achieve not only the control of symptoms, but deep remission, which is related with a favourable prognosis. Thus, the determination of biological markers or biomarkers of intestinal inflammation play a crucial role. Many biomarkers have been extensively evaluated in IBD showing significant correlation with endoscopic lesions, risk of recurrence and response to treatment. One of the most important markers is faecal calprotectin(FC). Despite calprotectin limitations, this biomarker represents a reliable and noninvasive alternative to reduce the need for endoscopic procedures. FC has demonstrated its performance for regular monitoring of IBD patients, not only to the diagnosis for discriminating IBD from non-IBD diagnosis, but for assessing disease activity, relapse prediction and response to therapy. Although, FC provides better results than other biomarkers such as C-reactive protein and erythrocyte sedimentation rate, these surrogate markers of intestinal inflammation should not be used isolation but in combination with other clinical, endoscopic, radiological or/and histological parameters enabling a comprehensive assessment of IBD patients.

穴位贴敷联合乌梅丸加减治疗寒热错杂型溃疡性结肠炎的临床效果

目的探索穴位贴敷联合乌梅丸加减对寒热错杂型溃疡性结肠炎患者的临床疗效、免疫功能、粪钙卫蛋白(FC)及血常规的影响。方法选取2019年1月至2021年1月徐州市中医院收治的60例寒热错杂型溃疡性结肠炎患者作为研究对象,按照就诊先后顺序分为对照组和观察组,各30例。对照组服用乌梅丸加减,观察组在对照组基础上联合穴位贴敷。比较两组临床疗效、溃疡性结肠炎活动度指数评分、外周血T淋巴细胞亚群(CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+))水平、FC、全血细胞计数。结果两组治疗后临床有效率、CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)高于治疗前,且观察组高于对照组,差异有统计学意义(P<0.05),两组治疗后Sutherland疾病活动指数评分、CD8^(+)水平、FC低于治疗前,且治疗后观察组低于对照组,差异有统计学意义(PP<0.05)。两组治疗前后白细胞(WBC)、红细胞(RBC)、血红蛋白(Hb)计数比较,差异无统计学意义(P>0.05)。结论穴位贴敷联合乌梅丸加减安全有效,对于寒热错杂型溃疡性结肠炎不能耐受水杨酸制剂患者可以改善患者临床症状,减轻炎症反应,增强免疫功能。

Hepatobiliary system and intestinal injury in new coronavirus infection(COVID-19):A retrospective study

BACKGROUND An important area of effective control of the coronavirus disease 19(COVID-19)pandemic is the study of the pathogenic features of severe acute respiratory syndrome coronavirus 2 infection,including those based on assessing the state of the intestinal microbiota and permeability.AIM To study the clinical features of the new COVID-19 in patients with mild and moderate severity at the stage of hospitalization,to determine the role of hepatobiliary injury,intestinal permeability disorders,and changes in the qualitative and quantitative composition of the microbiota in the development of systemic inflammation in patients with COVID-19.METHODS The study was performed in 80 patients with COVID-19,with an average age of 45 years,19 of whom had mild disease,and 61 had moderate disease severity.The scope of the examination included traditional clinical,laboratory,biochemical,instrumental,and radiation studies,as well as original methods for studying microbiota and intestinal permeability.RESULTS The clinical course of COVID-19 was studied,and the clinical and biochemical features,manifestations of systemic inflammation,and intestinal microbiome changes in patients with mild and moderate severity were identified.Intestinal permeability characteristics against the background of COVID-19 were evaluated by measuring levels of proinflammatory cytokines,insulin,faecal calprotectin,and zonulin.CONCLUSION This study highlights the role of intestinal permeability and microbiota as the main drivers of gastroenterological manifestations and increased COVID-19 severity.

粪便钙卫蛋白检测诊断结直肠癌87例

目的:比较粪便钙卫蛋白、便潜血试验及血清CEA在结直肠癌诊断中的应用价值.方法:研究组共纳入肠镜证实的87例结直肠癌初诊患者,对照组60例接受肠镜检查的健康成人.所有研究对象在接受肠镜检查时留取大便标本,检测便潜血及粪便钙卫蛋白,肠镜检查后抽取静脉血4mL,用于检测血清CEA.随访患者手术记录及手术病理.结果:粪便钙卫蛋白、便潜血试验及血清CEA诊断结直肠癌的敏感性分别为88.51%、83.91%和44.83%,特异性分别为88.33%、96.67%和93.33%.Dukes分期为A和B期患者便潜血试验及血清CEA的阳性率明显低于C和D期患者(P=0.0173,0.0059),Dukes不同分期的患者中,粪便钙卫蛋白的阳性率无明显差异;不同部位的结直肠癌与粪便钙卫蛋白、大便潜血试验及血清CEA的阳性率无显著差异;钙卫蛋白联合应用FOBT或/和CEA检测结直肠癌可以一定限度地提高其敏感性,但三种联合检测组合较单用粪便钙卫蛋白检测均无显著性差异.结论:粪便钙卫蛋白检测结直肠癌有较高的敏感性,且不受肿瘤分期的影响,可以作为门诊筛查结直肠癌的标志物.

Emerging role of colorectal mucus in gastroenterology diagnostics

Colonoscopy is currently the gold standard for diagnosis of inflammatory bowel disease(IBD)and colorectal cancer(CRC).This has the obvious drawback of being invasive as well as carrying a small risk.The most widely used non-invasive approaches include the use of faecal calprotectin in the case of IBD and fecal immunochemical test in the case of CRC.However,the necessity of stool collection limits their acceptability for some patients.Over the recent years,there has been emerging data looking at the role of non-invasively obtained colorectal mucus as a screening and diagnostic tool in IBD and CRC.It has been shown that the mucus rich material obtained by self-sampling of anal surface following defecation,can be used to measure various biomarkers that can aid in diagnosis of these conditions.

Comparison of a New Magnetic Resonance Imaging Protocol and Magnetic Resonance Follow-Through in Patients with Inflammatory Bowel Disease—A Prospective Pilot Study

Objective: Inflammatory bowel disease (IBD) is a chronic disease, consisting of two main subgroups: Crohn’s disease (CD) and ulcerative colitis (UC). Imaging is an essential component in the treatment of IBD and is used repeatedly to determine activity and severity of inflammatory lesions. The aim of our study was to prospectively obtain pilot data on the accuracy of magnetic resonance imaging with no oral contrast (MRI-NOC) and magnetic resonance follow-through (MRFT) using endoscopy as the reference standard. Materials and Methods: Patients diagnosed with CD and UC referred to magnetic resonance imaging (MRI) were included in this study population. For the evaluation, the bowel was divided into 9 segments. Two radiologists, blinded to clinical findings, evaluated bowel wall thickness, diffusion weighted imaging and mural hyperenhancement. Results: 14 patients (9 males and 5 females;median age 41;range 20 - 62) underwent both type of MRI examinations;9 had CD and 5 had UC. The overall sensitivity for small bowel was zero for both MRI protocols, as neither identified any lesions, whereas in colon the sensitivity ranged from 7% to 29% in MRI-NOC and 14% - 29% in MRFT. Specificity and accuracy in MRI-NOC ranged from 78% to 98% and 74% - 93%, respectively, in small bowel, and from 90% to 96% and 77% - 82%, respectively, in colon. Specificity and accuracy in MRFT ranged from 83% to 100% and 79% - 95%, respectively, in small bowel, while it ranged from 93% to 97% and 81% - 85%, respectively, in colon. Conclusion: The location of lesions in the colon combined with the lack of oral contrast in the colon renders MRFT and MRI-NOC functionally identical.

Combined evaluation of biomarkers as predictor of maintained remission in Crohn's disease

BACKGROUND The individual performances and the complementarity of Crohn's disease(CD)activity index(CDAI), C-reactive protein(CRP) and faecal calprotectin(Fcal) to monitor patients with CD remain poorly inves-tigated in the era of "tight control"and "treat to target" strategies.AIM To assess CDAI, CRP and Fcal variation, alone or combined, after 12 wk(W12) of anti-tumor necrosis factor(TNF) therapy to predict corticosteroids-free remission(CFREM = CDAI < 150, CRP < 2.9 mg/L and Fcal < 250 μg/g with no therapeutic intensification and no surgery) at W52.METHODS CD adult patients needing anti-TNF therapy with CDAI > 150 and either CRP >2.9 mg/L or Fcal > 250 μg/g were prospectively enrolled.RESULTS Among the 40 included patients, 13 patients(32.5%) achieved CFREM at W52. In univariable analysis, CDAI < 150 at W12(P = 0.012), CRP level < 2.9 mg/L at W12(P = 0.001) and Fcal improvement at W12(Fcal < 300 μg/g; or, for patients with initial Fcal < 300 μg/g, at least 50% decrease of Fcal or normalization of Fcal(< 100 μg/g)(P = 0.001) were predictive of CFREM at W52. Combined endpoint(CDAI < 150 and CRP ≤ 2.9 mg/L and FCal improvement) at W12 was the best predictor of CFREM at W52 with positive predictive value = 100.0%(100.0-100.0)and negative predictive value = 87.1%(75.3-98.9). In multivariable analysis, Fcal improvement at W12 [odd ratio(OR) = 45.1(2.96-687.9); P = 0.03] was a better predictor of CFREM at W52 than CDAI < 150 [OR = 9.3(0.36-237.1); P = 0.145]and CRP < 2.9 mg/L(0.77-278.0; P = 0.073).CONCLUSION The combined monitoring of CDAI, CRP and Fcal after anti-TNF induction therapy is able to predict favorable outcome within one year in patients with CD.

粪便钙卫蛋白检测在腹泻鉴别诊断中的意义

目的 分析粪便钙卫蛋白(fecal calprotectin,FCP)检测用于鉴别诊断腹泻的临床意义。方法 选取2021年6月—2022年5月盐城市第一人民医院就诊的600例单纯腹泻患者设为腹泻组,选取同时间段本院30例大肠癌患者设为大肠癌组,30例腹泻型肠易激综合征(diarrhea type of irritable bowel syndrome,D-IBS)患者设为D-IBS组,30例健康体检者设为对照组,四组均开展FCP检测,比较各组的FCP水平及阳性率差异。结果 四组FCP水平及阳性率相比,单纯腹泻组的FCP水平及阳性率分别为(514.32±128.64)μg/g、93.17%,远远高于大肠癌组[(335.46±58.96)μg/g、83.33%]、D-IBS组[(35.14±6.78)μg/g、10.00%]和对照组[(25.82±4.30)μg/g、3.33%],差异有统计学意义(P <0.05)。结论 FCP检测作为一类无创、迅速且简便的检测方式,能为临床鉴别诊断单纯腹泻和大肠癌、D-IBS等疾病提供一定的参考依据。

肠炎清合剂联合美沙拉嗪肠溶片维持治疗缓解期溃疡性结肠炎的临床疗效

目的:评价肠炎清合剂联合美沙拉嗪肠溶片维持治疗缓解期溃疡性结肠炎(UC)的临床疗效。方法:将140例符合要求的缓解期UC患者按照随机数字表法分为观察组和对照组,各70例。对照组脱落、失访6例,剔除3例,完成61例;观察组脱落、失访5例,剔除2例,完成63例。两组均给予生活方式调整,并内服美沙拉嗪肠溶片,0.5 g/次,3次/d,维持治疗。观察组,肠炎清合剂,150 mL/次,每日早、晚2次服用,连续1个月;然后改为150 mL/次,1次/d,连续3个月;然后为隔日1次,连续8个月。对照组,口服肠炎清合剂模拟药,方法同观察组。两组连续治疗12个月,若治疗期间UC复发,采用美沙拉嗪肠溶片,1 g/次,3次/d,口服,直到病情缓解后继续采用以上干预方案。记录12个月内的复发率、首次复发时间(本次研究中病情缓期后至Mayo评分系统≥3分的时间)和复发时疾病活动程度;中医证评分和炎症性肠病问卷(IBDQ)每2个月评价1次;治疗前、治疗后6个月和12个月各进行1次肠镜和黏膜组织学检查,进行肠镜下黏膜评分,黏膜组织学Geboes指数评价,并检测粪便钙卫蛋白(FC)水平。进行安全性评价。结果:在12个月期间,观察组复发率20.63%(13/63),低于对照组的39.34%(24/61)(χ^(2)=4.369,P<0.05);观察组平均复发次数少于对照组和首次复发时间长于对照组(P<0.01);观察组患者在复发时疾病活动情况轻于对照组(χ^(2)=5.947,P<0.05);在12个月期间两组患者的中医证候评分,肠镜下黏膜评分,Geboes指数和FC水平逐渐升高(P<0.05),IBDQ评分逐渐下降(P<0.05),在治疗后2,4,6,8,10,12个月各时间点,观察组患者中医证候评分均低于对照组(P<0.01),IBDQ评分高于对照组(P<0.01);在治疗后6,12个月,观察组患者肠镜下黏膜评分,Geboes指数和FC水平均低于对照组(P<0.01)。未发现与肠炎清合剂相关不良反应。结论:肠炎清合剂联合美沙拉嗪肠溶片维持治疗缓解期UC患者,可控制FC水平,进一步降低复发率、推迟复发时间、减少复发次数和减轻复发时的病情活动度,可维持UC良好缓解状态,稳定患者的生活质量,且临床使用安全。

门诊慢性腹泻患者粪便钙卫蛋白检测的临床价值

目的评价粪便钙卫蛋白对门诊慢性腹泻患者鉴别诊断的临床价值。方法选取慢性腹泻患者120例。其中肠易激综合征患者48例,炎性肠道疾病患者42例,大肠癌患者20例,脂肪泻患者10例。选取健康体检者25例作为对照。留取粪便用酶联免疫法对钙卫蛋白进行检测。结果 IBS患者FC水平与健康人相比无统计学差异。IBD、大肠癌和脂肪泻患者的FC水平显著高于健康人和功能性疾病IBS患者(P<0.05)。器质性疾病组两两比较,IBD组FC浓度显著高于大肠癌组和脂肪泻组(P<0.05),大肠癌组也高于脂肪泻组(P<0.05)。结论粪便钙卫蛋白检测作为一种非侵入性筛选试验,可为临床鉴别诊断慢性腹泻提供一种新指标。