Thomas P, Rihani H, Røseth A, Sigthorsson G, Price A, Nicholls R J, Bjarnason I
Department of Surgery, St. Mark's and Northwick Park Hospitals, London, United Kingdom.
Dis Colon Rectum. 2000 Feb;43(2):214-20. doi: 10.1007/BF02236986.
Assessment of inflammation within the ileal pouch to establish a diagnosis of "pouchitis" requires both pouch endoscopy and biopsy because there can be a poor correlation between macroscopic and histologic assessments of inflammation. A simplified diagnostic test would be of clinical advantage. Calprotectin is a stable myelomonocytic protein, measurable in feces. It quantitatively relates to inflammation within the gastrointestinal tract. This study was designed to compare single and 24-hour stool measurements of calprotectin in patients with and without evidence of ileal pouch inflammation with endoscopic, histologic, and immunohistochemical indices.
Twenty-four-hour stool collections were made in ileal pouch patients, 9 with and 15 without (7 with ulcerative colitis and 8 with familial polyposis coli) evidence of pouch inflammation. First-morning stool concentration and total 24-hour calprotectin were quantified by use of a single step enzyme-linked immunosorbent assay. Biopsies from the reservoir were taken for conventional histology and scoring of intraepithelial neutrophil infiltrate. Cells positive for CD3, CD45RO, CD14, and CD15 within the lamina propria were quantified by use of immunohistochemistry.
The mean first-morning stool calprotectin concentration correlated with the 24-hour level (r = 0.91; P = <0.0001). The median single-stool calprotectin concentrations were 39 mg/l, 4 mg/l, and 8.5 mg/l (normal range, 0.2-10 mg/l) in patients with inflamed, noninflamed ulcerative colitis, and familial adenomatous polyposis, respectively. All nine patients with endoscopic and histologic evidence of pouch inflammation had raised stool calprotectin. Two of 15 patients without evidence of pouch inflammation had abnormal stool calprotectin. Single-stool calprotectin concentration correlated with the percentage of mature granulocytes (CD15; r = 0.46; P = 0.04) and activated macrophages (CD14; r = 0.65; P = 0.006), but not memory T cells (CD45RO; r = -0.05; P = 0.4) within the lamina propria.
Single first-morning stool calprotectin levels provide a quantitative measure of pouch inflammation, which may be helpful in the diagnosis and assessment of pouchitis.
评估回肠储袋内的炎症以诊断“储袋炎”，既需要进行储袋内镜检查，也需要活检，因为炎症的宏观评估与组织学评估之间可能存在较差的相关性。一种简化的诊断测试将具有临床优势。钙卫蛋白是一种稳定的骨髓单核细胞蛋白，可在粪便中检测到。它与胃肠道内的炎症定量相关。本研究旨在比较有和没有回肠储袋炎症证据的患者单次及24小时粪便钙卫蛋白测量值与内镜、组织学和免疫组化指标之间的关系。
对回肠储袋患者进行24小时粪便收集，其中9例有储袋炎症证据，15例无（7例患有溃疡性结肠炎，8例患有家族性腺瘤性息肉病）。使用单步酶联免疫吸附测定法定量测定首次晨尿粪便浓度和24小时总钙卫蛋白。从储袋取活检组织进行常规组织学检查并对上皮内中性粒细胞浸润进行评分。通过免疫组化对固有层内CD3、CD45RO、CD14和CD15阳性细胞进行定量。
首次晨尿粪便钙卫蛋白平均浓度与24小时水平相关（r = 0.91；P = <0.0001）。有炎症、无炎症的溃疡性结肠炎和家族性腺瘤性息肉病患者的单次粪便钙卫蛋白浓度中位数分别为39 mg/l、4 mg/l和8.5 mg/l（正常范围，0.2 - 10 mg/l）。所有9例有内镜和组织学证据表明储袋有炎症的患者粪便钙卫蛋白升高。15例无储袋炎症证据的患者中有2例粪便钙卫蛋白异常。单次粪便钙卫蛋白浓度与固有层内成熟粒细胞百分比（CD15；r = 0.46；P = 0.04）和活化巨噬细胞百分比（CD14；r = 0.65；P = 0.006）相关，但与记忆T细胞（CD45RO；r = -0.05；P = 0.4）无关。
首次晨尿单次粪便钙卫蛋白水平可提供储袋炎症的定量测量，这可能有助于储袋炎的诊断和评估。
