Fecal calprotectin in pediatric gastrointestinal diseases:Pros and cons

BACKGROUND Fecal calprotectin is a valuable biomarker for assessing intestinal inflammation in pediatric gastrointestinal diseases.However,its role,pros,and cons in various conditions must be comprehensively elucidated.AIM To explore the role of fecal calprotectin in pediatric gastrointestinal diseases,including its advantages and limitations.METHODS A comprehensive search was conducted on PubMed,PubMed Central,Google Scholar,and other scientific research engines until February 24,2024.The review included 88 research articles,56 review articles,six metaanalyses,two systematic reviews,two consensus papers,and two letters to the editors.RESULTS Fecal calprotectin is a non-invasive marker for detecting intestinal inflammation and monitoring disease activity in pediatric conditions such as functional gastrointestinal disorders,inflammatory bowel disease,coeliac disease,coronavirus disease 2019-induced gastrointestinal disorders,gastroenteritis,and cystic fibrosis-associated intestinal pathology.However,its lack of specificity and susceptibility to various confounding factors pose challenges in interpretation.Despite these limitations,fecal calprotectin offers significant advantages in diagnosing,monitoring,and managing pediatric gastrointestinal diseases.CONCLUSION Fecal calprotectin holds promise as a valuable tool in pediatric gastroenterology,offering insights into disease activity,treatment response,and prognosis.Standardized protocols and guidelines are needed to optimize its clinical utility and mitigate interpretation challenges.Further research is warranted to address the identified limitations and enhance our understanding of fecal calprotectin in pediatric gastrointestinal diseases.

Comparison of fecal calprotectin levels and endoscopic scores for predicting relapse in patients with ulcerative colitis in remission

BACKGROUND Although the usefulness of endoscopic scores,such as the Mayo Endoscopic Subscore(MES),Ulcerative Colitis Endoscopic Index of Severity(UCEIS),and Ulcerative Colitis Colonoscopic Index of Severity(UCCIS),and biomarkers such as fecal calprotectin(FC)for predicting relapse in ulcerative colitis(UC)has been reported,few studies have included endoscopic scores for evaluating the entire colon.AIM To compare the usefulness of FC value and MES,UCEIS,and UCCIS for predicting relapse in patients with UC in clinical remission.METHODS In total,75 patients with UC in clinical and endoscopic remission who visited our institution between February 2019 and March 2022 were enrolled.The diagnosis of UC was confirmed based on the clinical presentation,endoscopic findings,and histology,according to the current established criteria for UC.Fecal samples were collected the day before or after the colonoscopy for measurement of FC.Endoscopic evaluations were performed using MES,UCEIS,and UCCIS.The primary outcome measure of this study was the assessment of the association between relapse within 12 mo and MES,UCEIS,UCCIS,and FC.The secondary outcome was the comparison between endoscopic scores and biomarkers in en-rolled patients with UC with mucosal healing.RESULTSFC and UCCIS showed a significant correlation with UCEIS (r = 0.537, P < 0.001 and r = 0.957, P < 0.001, respectively).Receiver-operating characteristic analysis for predicting MES 0 showed that the area under the curve ofUCCIS was significantly higher than that of FC (P < 0.01). During the 1-year observation period, 18 (24%) patientsexperienced a relapse, and both the FC and UCCIS of the relapse group were significantly higher than that of theremission group. The cut-off values for predicting relapse were set at FC = 323 mg/kg and UCCIS = 10.2. The areaunder the curve of the receiver-operating characteristic analysis for predicting relapse did not show a significantdifference between FC and UCCIS. The accuracy of the endoscopic scores and biomarkers in predicting relapse was86.7% for UCCIS, 85.3% for UCEIS, 76.0% for FC, and 73.3% for MES.CONCLUSIONThe three endoscopic scores and FC may predict UC relapse during clinical remission. Among these scores, UCEISmay be the most useful in terms of ease of evaluation and accuracy.

Fecal calprotectin measurement is a marker of shortterm clinical outcome and presence of mucosal healing in patients with inflammatory bowel disease

AIM To evaluate the utility of fecal calprotectin(FC) in predicting relapse and endoscopic activity during follow-up in an inflammatory bowel disease(IBD) cohort.METHODS All FC measurements that were obtained during a 3-year period from patients with inflammatory bowel disease in clinical remission were identified. Data regarding the short-term(6 mo) course of the disease were extracted from the medical files. Exclusion criteria were defined as:(1) An established flare of the disease at the time of FC measurement,(2) Loss to follow up within 6 mo from baseline FC measurement, and,(3) Insufficient data on file. Statistical analysis was performed to evaluate whether baseline FC measurement could predict the short term clinical relapse and/or the presence of mucosal healing.RESULTS We included 149 [Crohn's disease(CD) = 113, Ulcerative colitis(UC) = 36, male = 77] IBD patients in our study. Within the determined 6-month period post-FC measurement, 47(31.5%) had a disease flare. Among 76 patients who underwent endoscopy, 39(51.3%) had mucosal healing. Baseline FC concentrations were significantly higher in those who had clinical relapse compared to those who remained in remission during follow up(481.0 μg/g, 286.0-600.0 vs 89.0, 36.0-180.8, P < 0.001). The significant predictive value of baseline median with IQR FC for clinical relapse was confirmed by multivariate Cox analysis [HR for 100μg/g: 1.75(95%CI: 1.28-2.39), P = 0.001]. Furthermore, lower FC baseline values significantly correlated to the presence of mucosal healing in endoscopy(69.0 μg/g, 30.0-128.0 vs 481.0, 278.0-600.0, in those with mucosal inflammation, median with IQR, P < 0.001). We were able to extract cut-off values for FC concentration with a high sensitivity and specificity for predicting clinical relapse(261 μg/g with AUC = 0.901, sensitivity 87.2%, specificity 85.3%, P < 0.001) or mucosal healing(174 μg/g with AUC = 0.956, sensitivity 91.9%, specificity 87.2%, P < 0.001). FC was better than CRP in predicting either outcome; nevertheless, having a pathological CRP(> 5 mg/L) in addition to the cutoffs for FC, significantly enhanced the specificity for predicting clinical relapse(95.1% from 85.3%) or endoscopic activity(100% from 87.2%). CONCLUSION Serial FC measurements may be useful in monitoring IBD patients in remission, as FC appears to be a reliable predictor of short-term relapse and endoscopic activity.

Can chronic gastritis cause an increase in fecal calprotectin concentrations?

AIM:To evaluate fecal calprotectin concentrations(FCCs) in subjects with chronic gastritis and the correlation between FCCs and gastritis activity score.METHODS:FCCs were measured in 61 patients with histological diagnosis of gastritis and in 74 healthy volunteers.Histological grading of gastritis was performed according to the updated Sydney gastritis classification.Patients were subdivided into 2 groups according to the presence/absence of an active gastritis.Patients with chronic active gastritis were divided into 3 subgroups on the basis of the activity score(mild,moderate,marked).FFCs in relation to Helicobacter pylori(H.pylori) infection and proton pump inhibitor(PPI) use were also evaluated.RESULTS:FCCs in patients with chronic active gastritis were not significantly different to FCCs either in subjects with non active gastritis or in healthy controls.Among patients with chronic active gastritis(even marked),FCCs did not significantly differ according to activity score.No significant differences in FCCs were found when considering H.pylori,as well as when considering PPI chronic use.CONCLUSION:FCCs were not significantly increased in subjects with chronic gastritis,even in those patients with a marked neutrophil infiltration.

High fecal calprotectin levels are associated with SARS-CoV-2 intestinal shedding in COVID-19 patients:A proof-of-concept study

BACKGROUND One third of coronavirus disease 2019(COVID-19)patients have gastrointestinal symptoms.Severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)RNA has been detected in stool samples of approximately 50%of COVID-19 individuals.Fecal calprotectin is a marker of gastrointestinal inflammation in the general population.AIM To investigate if fecal calprotectin correlates with SARS-CoV-2 intestinal shedding in COVID-19 patients with pneumonia.METHODS Patients with SARS-CoV-2 pneumonia admitted to the Infectious Disease Unit(University Hospital of Trieste,Italy)from September to November 2020 were consecutively enrolled in the study.Fecal samples were collected and analyzed for quantification of fecal calprotectin(normal value<50 mg/kg)and SARS-CoV-2 RNA presence by polymerase chain reaction(PCR).Inter-group differences were determined between patients with and without diarrhea and patients with and without detection of fecal SARS-CoV-2.RESULTS We enrolled 51 adults(40 males)with SARS-CoV-2 pneumonia.Ten patients(20%)presented with diarrhea.Real-time-PCR of SARS-CoV-2 in stools was positive in 39 patients(76%),in all patients with diarrhea(100%)and in more than two thirds(29/41,71%)of patients without diarrhea.Obesity was one of the most common comorbidities(13 patients,25%);all obese patients(100%)(P=0.021)tested positive for fecal SARS-CoV-2.Median fecal calprotectin levels were 60 mg/kg[interquartile range(IQR)21;108];higher fecal calprotectin levels were found in the group with SARS-CoV-2 in stools(74 mg/kg,IQR 29;132.5)compared to the group without SARS-CoV-2(39 mg/kg,IQR 14;71)(P<0.001).CONCLUSION High fecal calprotectin levels among COVID-19 patients correlate with SARSCoV-2 detection in stools supporting the hypothesis that this virus can lead to bowel inflammation and potentially to the‘leaky gut’syndrome.

Clinical value of fecal calprotectin in determining disease activity of ulcerative colitis

AIM: To investigate possibility and clinical application of fecal calprotectin in determining disease activity of ulcerative colitis (UC).METHODS: The enzyme-linked immunosorbent assay (ELISA) was used to measure the concentrations of calprotectin in feces obtained from 66 patients with UC and 20 controls. C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), acid glycoprotein (AGP) were also measured and were compared with calprotectin in determining disease activity of UC. The disease activity of UC was also determined by the Sutherland criteria.RESULTS: The fecal calprotectin concentration in the patients with active UC was significantly higher than that in the inactive UC and in the controls (402.16 ± 48.0 μg/g vs 35.93 ± 3.39 μg/g, 11.5 ± 3.42 μg/g, P < 0.01). The fecal calprotectin concentration in the inactive UC group was significantly higher than that in the control group (P < 0.05). A significant difference was also found in the patients with active UC of mild, moderate and severe degrees. The area under the curve of the receiver operating characteristics (AUCROC) was 0.975, 0.740, 0.692 and 0.737 for fecal calprotectin, CRP, ESR and AGP, respectively. There was a strong correlation between the fecal calprotectin concentration and the endoscopic gradings for UC (r = 0.866, P < 0.001).CONCLUSION: Calprotectin in the patient's feces can reflect the disease activity of UC and can be used as a rational fecal marker for intestinal inflammation in clinical practice. This kind of marker is relatively precise, simple and noninvasive when compared with other commonly-used markers such as CRP, ESR and AGP.

From bench to bedside: Fecal calprotectin in inflammatory bowel diseases clinical setting

Fecal calprotectin(FC) has emerged as one of the most useful tools for clinical management of inflammatory bowel diseases(IBD). Many different methods of assessment have been developed and different cutoffs have been suggested for different clinical settings. We carried out a comprehensive literature review of the most relevant FC-related topics: the role of FC in discriminating between IBD and irritable bowel syndrome(IBS) and its use in managing IBD patients In patients with intestinal symptoms, due to the high negative predictive value a normal FC level reliably rules out active IBD. In IBD patients a correlation with both mucosal healing and histology was found, and there is increasing evidence that FC assessment can be helpful in monitoring disease activity and response to therapy as well as in predicting relapse, post-operative recurrence or pouchitis. Recently, its use in the context of a treat-to-target approach led to a better outcome than clinically-based therapy adjustment in patients with early Crohn's disease. In conclusion, FC measurement represents a cheap, safe and reliable test, easy to perform and with a good reproducibility. The main concerns are still related to the choice of the optimal cut-off, both for differentiating IBD from IBS, and for the management of IBD patients.

Fecal calprotectin correlated with endoscopic remission for Asian inflammatory bowel disease patients

AIM: To evaluate the correlation between fecal calprotectin(f C), C-reactive protein(CRP), and endoscopic disease score in Asian inflammatory bowel disease(IBD) patients.METHODS: Stool samples were collected and assessed for calprotectin levels by Quantum Blue Calprotectin High Range Rapid test. Crohn's disease endoscopic index of severity(CDEIS) and ulcerative colitis endoscopic index of severity(UCEIS) were used for endoscopic lesion scoring. RESULTS: A total of 88 IBD patients [36 patients with Crohn's disease(CD) and 52 with ulcerative colitis(UC)] were enrolled. For CD patients, f C correlated with CDEIS(r = 0.465, P = 0.005) and CRP(r = 0.528, P = 0.001). f C levels in UC patients correlated with UCEIS(r = 0.696, P < 0.0001) and CRP(r = 0.529, P = 0.0005). Calprotectin could predict endoscopic remission(CDEIS < 6) with 50% sensitivity and 100% specificity(AUC: 0.74) in CD patients when using 918 μg/g as the cutoff. When using 191 μg/g as the cut-off in UC patients, calprotectin could be used for predicting endoscopic remission(UCEIS < 3) with 88% sensitivity and 75% specificity(AUC: 0.87). CONCLUSION: f C correlated with both CDEIS and UCEIS. f C could be used as a predictor of endoscopic remission for Asian IBD patients.

Consecutive fecal calprotectin measurements for predicting relapse in pediatric Crohn's disease patients

BACKGROUND Asymptomatic children with Crohn's disease(CD) require ongoing monitoring to ensure early recognition of a disease exacerbation.AIM In a cohort of pediatric CD patients, we aimed to assess the utility of serial fecal calprotectin measurements to detect intestinal inflammatory activity and predict disease relapse.METHODS In this prospective longitudinal cohort study, children with CD on infliximab therapy in clinical remission were included. Fecal calprotectin levels were assessed at baseline and at subsequent 2-5 visits. Clinical and biochemical disease activity were assessed using the Pediatric Crohn's Disease Activity Index, Creactive protein and erythrocyte sedimentation rate at baseline and at visits over the following 18 mo.RESULTS 53 children were included and eighteen patients(34%) had a clinical disease relapse during the study. Baseline fecal calprotectin levels were higher in patients that developed symptomatic relapse [median(interquartile range), relapse 723μg/g(283-1758) vs 244 μg/g(61-627), P = 0.02]. Fecal calprotectin levels > 250μg/g demonstrated good predictive accuracy of a clinical flare within 3 mo(area under the receiver operator curve was 0.86, 95% confidence limits 0.781 to 0.937).CONCLUSION Routine fecal calprotectin testing in children with CD in clinical remission is useful to predict relapse. Levels > 250 μg/g are a good predictor of relapse in the following 3 mo. This information is important to guide monitoring standards used in this population.

FOCUS: Future of fecal calprotectin utility study in inflammatory bowel disease

AIM To evaluate the perspective of gastroenterologists regarding the impact of fecal calprotectin(FC) on the management of patients with inflammatory bowel disease(IBD).METHODS Patients with known IBD or symptoms suggestive of IBD for whom the physician identified that FC would be clinically useful were recruited. Physicians completed an online "pre survey" outlining their rationale for the test. After receipt of the test results, the physicians completed an online "post survey" to portray their perceived impact of the test result on patient management. Clinical outcomes for a subset of patients with follow-up data available beyond the completion of the "post survey" were collected and analyzed.RESULTS Of 373 test kits distributed, 290 were returned, resulting in 279 fully completed surveys. One hundred and ninety patients were known to have IBD; 147(77%) with Crohn's Disease, 43(21%) Ulcerative Colitis and 5(2%) IBD unclassified. Indications for FC testing included: 90(32.2%) to differentiate a new diagnosis of IBD from Irritable Bowel Syndrome(IBS), 85(30.5%) to distinguish symptoms of IBS from IBD in those known to have IBD and 104(37.2%) as an objective measure of inflammation. FC levels resulted in a change in management 51.3%(143/279) of the time which included a significant reduction in the number of colonoscopies(118) performed(P < 0.001). Overall, 97.5%(272/279) of the time, the physicians found the test sufficiently useful that they would order it again in similar situations. Follow-up data was available for 172 patients with further support for the clinical utility of FC provided.CONCLUSION The FC test effected a change in management 51.3% of the time and receipt of the result was associated with a reduction in the number of colonoscopies performed.

Relevance of fecal calprotectin and lactoferrin in the postoperative management of inflammatory bowel diseases

The role of fecal lactoferrin and calprotectin has been extensively studied in many areas of inflammatory bowel disease(IBD) patients' management. The postoperative setting in both Crohn's disease(CD) and ulcerative colitis(UC) patients has been less investigated although few promising results come from small, crosssectional studies. Therefore, the current post-operative management still requires endoscopy 6-12 mo after intestinal resection for CD in order to exclude endoscopic recurrence and plan the therapeutic strategy. In patients who underwent restorative proctocolectomy, endoscopy is required whenever symptoms includes the possibility of pouchitis. There is emerging evidence that fecal calprotectin and lactoferrin are useful surrogate markers of inflammation in the post-operative setting, they correlate with the presence and severity of endoscopic recurrence according to Rutgeerts' score and possibly predict the subsequent clinical recurrence and response to therapy in CD patients. Similarly, fecal markers show a good correlation with the presence of pouchitis, as confirmed by endoscopy in operated UC patients. Fecal calprotectin seems to be able to predict the short-term development of pouchitis in asymptomatic patients and to vary according to response to medical treatment. The possibility of both fecal markers to used in the routine clinical practice for monitoring IBD patients in the postoperative setting should be confirmed in multicentric clinical trial with large sample set. An algorithm that can predict the optimal use and timing of fecal markers testing, the effective need and timing of endoscopy and the cost-effectiveness of these as a strategy of care would be of great interest.

A New Immunofluorescence Assay for Fecal Calprotectin Distinguishes Inflammatory Bowel Disease from Functional Bowel Disease

Aims: To investigate the diagnostic value of fecal calprotectin (FC) determined by a new immunofluorescence assay-fluorescence enzyme immunoassay (FEIA) in patient with inflammatory bowel disease (IBD) or functional bowel disease, compared with the typical ELISA kit. Methods: FC was determined simultaneously by FEIA and an ELISA kit in 26 patients with functional bowel disease and 77 patients with IBD. We compared the difference of FC levels between patients with IBD and patients with functional bowel disease. Receiver operating characteristics curve (ROC) was constructed to obtain the optimal cut-off value of FC for distinguishing IBD from functional bowel disease and the corresponding sensitivity and specificity. Results: The median FC levels of patients with IBD in clinical active stage or clinical remission stage was significantly higher than that of patients with functional bowel disease. The median FC levels of patients with IBD in clinical active stage, IBD in clinical remission stage and functional bowel disease were as follow: 699.91 (346.14 ~ 1647.54) μg/g;407.36 (121.81 ~ 878.48) μg/g;39.04 (12.09 ~ 81.04) μg/g when FC was measured by FEIA. The median FC levels were 716.99 (240.42 ~ 1232.53) μg/g;338.46 (53.08 ~ 692.82) μg/g;41.44 (11.77 ~ 73.19) μg/g among such above three groups of patients respectively, when FC was measured by ELISA kit. The diagnostic value of IBD with FC determined by FEIA (optimal cut-off = 131.79 μg/g) and ELISA kit (optimal cut-off = 121.85 μg/g) presented an area under the curve of 0.881 and 0.873, respectively. Conclusions: FC determined by FEIA was an accurate surrogate marker to distinguish IBD from functional bowel disease.

Diagnostic Value of Fecal Calprotectin and Serum MMP-9 in Diagnosing Disease Activity of Ulcerative Colitis

Background and Study Aim: Ulcerative colitis (UC) is a chronic, idiopathic inflammatory bowel disease characterized by remission of disease activity. Searching for laboratory markers which are simple, sensitive, specific and noninvasive is fundamental to assess the extent of inflammation, activity of the disease, evolution and prognosis which can be used to assess response to treatment and the possibility of relapse. Our aim of the work was to investigate the diagnostic role of fecal calprotectin and serum MMP-9 in determining the activity of ulcerative colitis. Patients and Methods: 71 patients were included in the study and fecal calprotectin, serum MMP-9, ESR and CRP were measured in these patients to determine the disease activity of ulcerative colitis. Results: Fecal calprotectin concentration in the patients with active UC was significantly higher than that in inactive disease and in controls (387.21 ± 44.07 μg/g vs 103.62 ± 119.67 μg/g, 12.44 ± 3.65 μg/g, p = 0.000). Serum MMP-9 was found to be higher in patients with active UC than in patients with inactive disease (11.02 ± 5.29 vs 4.01 ± 1.72 ng/ml, p = 0.000). A significant difference was also found in the patients with active UC of mild, moderate and severe degrees. Also, strong positive correlation was found between fecal calprotectin and serum MMP-9 and the severity of the disease. The area under the curve of the receiver operating characteristics (AUCROC) was 0.949 and 0.941 for fecal calprotectin and serum MMP-9 respectively. Conclusion: Fecal calprotectin and serum MMP-9 can be used to differentiate between active and inactive forms of UC.

Current status of fecal calprotectin as a diagnostic or monitoring biomarker for cow's milk protein allergy in children:a scoping review

Background There are few approved biomarkers for diagnosis and monitoring of cow's milk protein allergy(CMPA),thus the oral food challenge remains to be the golden diagnostic standard.A potential biomarker is fecal calprotectin,a cytosolic protein,elevating in the presence of intestinal mucosal inflammation.We aimed to undertake a scoping review of the evi-dence pertaining to the current status of fecal calprotectin used for diagnosis and monitoring CMPA in children,and tried to indicate the aspects needed to be concerned in the future investigations and researches.Methods A scoping review was performed using the literature searched from PUBMED,EMBASE,and Web of Science Databases until July 2019 on the studies about the application of fecal calprotectin as a biomarker of CMPA in children.Studies were examined according to the inclusion and exclusion criteria.Data were extracted,and a narrative synthesis was conducted to summarize and analyze.Results Thirteen studies with different study design embracing 1238 children were included.The age range was from infants to adolescents.Most children with CMPA presented gastrointestinal symptoms,among which hematochezia was most com-mon.Amount of data suggested that infants with CMPA represented elevated levels of fecal calprotectin,particularly with distinct significance in non-IgE-mediated CMPA groups.Decreases of fecal calprotectin after elimination diet were demon-strated in enrolled studies.However,no matter in the CMPA positive or negative groups,the changes of fecal calprotectin before or after challenge showed no significance.Contradictory results were generated from studies on the role of fecal calprotectin in predicting allergic disease.Conclusions Available evidence is not sufficient to confirm the utilization of fecal calprotectin both in diagnosis and moni-toring of CMPA and predicting for allergic disease.More clinical and bench researches with elaborate design should be conducted and the exact cut-off values of fecal calprotectin in different groups remain to be determined.

Fecal microbiota transplantation for the maintenance of remission in patients with ulcerative colitis:A randomized controlled trial

BACKGROUND Fecal microbial transplantation(FMT)is a promising new method for treating active ulcerative colitis(UC),but knowledge regarding FMT for quiescent UC is scarce.AIM To investigate FMT for the maintenance of remission in UC patients.METHODS Forty-eight UC patients were randomized to receive a single-dose FMT or autologous transplant via colonoscopy.The primary endpoint was set to the maintenance of remission,a fecal calprotectin level below 200μg/g,and a clinical Mayo score below three throughout the 12-mo follow-up.As secondary endpoints,we recorded the patient’s quality of life,fecal calprotectin,blood chemistry,and endoscopic findings at 12 mo.RESULTS The main endpoint was achieved by 13 out of 24(54%)patients in the FMT group and by 10 out of 24(41%)patients in the placebo group(log-rank test,P=0.660).Four months after FMT,the quality-of-life scores decreased in the FMT group compared to the placebo group(P=0.017).In addition,the disease-specific quality of life measure was higher in the placebo group than in the FMT group at the same time point(P=0.003).There were no differences in blood chemistry,fecal calprotectin,or endoscopic findings among the study groups at 12 mo.The adverse events were infrequent,mild,and distributed equally between the groups.CONCLUSION There were no differences in the number of relapses between the study groups at the 12-mo follow-up.Thus,our results do not support the use of a single-dose FMT for the maintenance of remission in UC.

粪便钙卫蛋白等炎症指标在儿童克罗恩病中的诊断价值

目的 探讨粪便钙卫蛋白(FC)、C反应蛋白(CRP)、红细胞沉降率(ESR)、白细胞介素6(IL-6)、肿瘤坏死因子(TNF)-α、肝素结合蛋白(HBP)在诊断儿童克罗恩病(CD)结肠黏膜状态中的应用价值。方法 选取2021年1月—2023年1月上海交通大学附属瑞金医院CD患儿85例。根据克罗恩病简化内镜评分(SES-CD)将患儿分为黏膜愈合组和黏膜病变组。另选取19例功能性胃肠病患儿作为对照组。检测所有研究对象FC、CRP、ESR、IL-6、TNF-α、HBP水平。结果 黏膜病变组FC、IL-6、TNF-α水平高于对照组(P<0.05)。黏膜病变组与黏膜愈合组比较,FC、CRP、ESR、IL-6、HBP差异均有统计学意义(P<0.05)。FC、CRP、ESR、IL-6与SES-CD呈正相关(P<0.05)。FC判断CD患儿黏膜病变的敏感性和特异性分别为84.2%和98.5%。结论 FC、CRP、ESR、IL-6、HBP水平与CD患儿黏膜病变状态、转归情况关系密切。FC或可作为判断CD患儿黏膜病变的指标。

粪钙卫蛋白、血浆D-二聚体在不同类型过敏性紫癜患儿中的表达水平及其诊断价值

目的:探讨粪钙卫蛋白、血浆D-二聚体在不同类型过敏性紫癜(HSP)患儿中的表达水平及其诊断价值。方法:选取2019年10月至2022年6月我科收治的66例首次发病的HSP儿童为病例组,分为腹型组(40例)与非腹型组(26例),非腹型组又细分为肾脏受累组(10例)和肾脏未受累组(16例)。选取同期我院50例健康体检儿童为对照组,比较各组粪钙卫蛋白与血浆D-二聚体水平,采用ROC曲线分析二者对HSP的诊断价值。结果:腹型组的粪钙卫蛋白、血浆D-二聚体水平高于非腹型组,非腹型组高于对照组(P<0.05)。肾脏受累组的血浆D-二聚体水平高于肾脏未受累组(P<0.05)。ROC曲线分析显示,粪钙卫蛋白、血浆D-二聚体诊断HSP的曲线下面积为0.890、0.919。粪钙卫蛋白、血浆D-二聚体水平与HSP患儿腹部受累程度呈正相关(r=0.676、0.630,P<0.05)。结论:粪钙卫蛋白、血浆D-二聚体可作为诊断儿童HSP的重要生物学标志,其表达水平与HSP腹部受累程度呈正相关。

炎症性肠病非侵入生物标志物的研究进展

炎症性肠病(Inflammatory bowel disease,IBD)是一组慢性非特异性炎症性肠道疾病,主要包括克罗恩病和溃疡性结肠炎。IBD的病因尚不完全明确,但被认为是遗传易感个体中环境因素、微生物、感染及免疫反应等多重因素交互作用的结果。目前内镜和病理学检查仍是常用的监测手段,但由于其是侵入性检测且价格昂贵,就医体验降低等不易被患者接受。近年来无创性生物标志物的研究为评估IBD患者的疾病状态和治疗效果提供了新的可能性。本文综述了血液、粪便和体液中的无创性生物标志物在IBD疾病诊疗中的应用潜力。在减少侵入性检测、优化个性化治疗策略以及早期识别疾病活动和缓解状态方面,通过综合应用这些生物标志物与临床参数,可以更加准确地评估患者疾病状态,调整治疗策略,为IBD患者提供更精细化、个体化的治疗,改善患者的预后和生活质量。

Fecal markers of inflammation used as surrogate markers for treatment outcome in relapsing inflammatory bowel disease

AIM: To evaluate fecal calprotectin (FC) as a surrogate marker of treatment outcome of relapse of inflammatory bowel disease (IBD) and, to compare FC with fecal myeloperoxidase (MPO) and fecal eosinophil protein X (EPX). METHODS: Thirty eight patients with IBD, comprising of 27 with ulcerative colitis (UC) and 11 with Crohn’s disease (CD) were investigated before treatment (inclusion), and after 4 and 8 wk of treatment. Treatment outcomes were evaluated by clinical features of disease activity and endoscopy in UC patients, and disease activity in CD patients. In addition, fecal samples were analyzed for FC by enzyme-linked immunosorbent assay (ELISA), and for MPO and EPX with radioimmunoassay (RIA). RESULTS: At inclusion 37 of 38 (97%) patients had elevated FC levels (> 94.7 μg/g). At the end of the study, 31 of 38 (82%) patients fulfilled predefined criteria of a complete response [UC 21/27 (78%); CD 10/11 (91%)]. Overall, a normalised FC level at the end of the study predicted a complete response in 100% patients, whereas elevated FC level predicted incomplete response in 30%. Normalised MPO or EPX levels predicted a complete response in 100% and90% of the patients, respectively. However, elevated MPO or EPX levels predicted incomplete response in 23% and 22%, respectively. CONCLUSION: A normalised FC level has the potential to be used as a surrogate marker for successful treatment outcome in IBD patients. However, patients with persistent elevation of FC levels need further evaluation. FC and MPO provide superior discrimination than EPX in IBD treatment outcome.

粪便钙卫蛋白检测对肠易激综合征和炎症性肠病的鉴别诊断价值分析

目的:探讨粪便钙卫蛋白检测对肠易激综合征(IBS)和炎症性肠病(IBD)的鉴别诊断价值。方法:选取2022年1月—2023年1月滨州医学院附属医院收治的200例IBD患者作为IBD组,200例IBS患者作为IBS组,选取同期100例体检健康者作为对照组。三组均进行粪便钙卫蛋白、C反应蛋白(CRP)检测。比较三组粪便钙卫蛋白、CRP水平以及IBS组、IBD组粪便钙卫蛋白和CRP阳性率。结果:IBS组与对照组粪便钙卫蛋白、CRP水平比较,差异无统计学意义(P>0.05);IBD组粪便钙卫蛋白、CRP水平高于对照组与IBS组,差异有统计学意义(P<0.001)。IBS组粪便钙卫蛋白和CRP阳性率比较,差异无统计学意义(P>0.05);IBD组粪便钙卫蛋白和CRP阳性率均高于IBS组,且粪便钙卫蛋白阳性率高于CRP阳性率,差异有统计学意义(P<0.001)。结论:粪便钙卫蛋白检测在IBD患者中阳性检出率较高,可以作为IBD的辅助诊断指标,用于鉴别诊断IBS和IBD。