von Roon Alexander C, Karamountzos Leonidas, Purkayastha Sanjay, Reese George E, Darzi Ara W, Teare Julian P, Paraskeva Paraskevas, Tekkis Paris P
Imperial College London, Department of Biosurgery and Surgical Technology, St. Mary's Hospital, London, United Kingdom.
Am J Gastroenterol. 2007 Apr;102(4):803-13. doi: 10.1111/j.1572-0241.2007.01126.x. Epub 2007 Feb 23.
Fecal calprotectin (FC) is a relatively new marker of intraluminal intestinal inflammation. Using meta-analytical techniques, the study aimed to evaluate the diagnostic precision of FC for inflammatory bowel disease (IBD) and colorectal cancer (CRC) in adults and children.
Quantitative meta-analysis was performed on prospective studies, comparing FC levels against the histological diagnosis. Sensitivity, specificity, and diagnostic odds ratio (DOR) were calculated for each study. Summary receiver-operating characteristic (sROC) curves and subgroup analysis were undertaken. Study quality and heterogeneity were evaluated.
Thirty studies of 5,983 patients were included. FC levels in patients with IBD were higher by 219.2 micrograms per gram (microg/g) compared with normal patients (P < 0.001). sROC curve analysis showed a sensitivity of 0.95 (95% CI 0.93-0.97), specificity of 0.91 (95% CI 0.86-0.91), and an area under the curve (AUC) of 0.95 for the diagnosis of IBD. Patients with colorectal neoplasia had nonsignificantly higher FC levels by 132.2 microg/g compared with noncancer controls (P= 0.18). Sensitivity and specificity of FC for the diagnosis of CRC were 0.36 and 0.71, respectively, with an AUC of 0.66. The diagnostic precision of FC for IBD was higher in children than adults with better accuracy at a cutoff level of 100 microg/g versus 50 microg/g. Sensitivity analysis and metaregression analysis did not significantly alter the results.
FC cannot be recommended as a screening test for CRC in the general population. FC appeared to offer a good diagnostic precision in distinguishing IBD from non-IBD diagnoses, with higher precision at a cutoff of 100 microg/g.
粪便钙卫蛋白（FC）是肠腔内肠道炎症的一种相对较新的标志物。本研究旨在运用荟萃分析技术评估FC对成人和儿童炎症性肠病（IBD）及结直肠癌（CRC）的诊断准确性。
对前瞻性研究进行定量荟萃分析，将FC水平与组织学诊断结果进行比较。计算每项研究的敏感性、特异性和诊断比值比（DOR）。绘制汇总的受试者工作特征（sROC）曲线并进行亚组分析。评估研究质量和异质性。
纳入了30项针对5983例患者的研究。与正常患者相比，IBD患者的FC水平每克高出219.2微克（μg/g）（P < 0.001）。sROC曲线分析显示，诊断IBD时的敏感性为0.95（9５%置信区间0.93 - 0.97），特异性为0.91（95%置信区间0.86 - 0.91），曲线下面积（AUC）为0.95。与非癌症对照组相比，结直肠肿瘤患者的FC水平每克高出132.2μg/g，但差异无统计学意义（P = 0.18）。FC诊断CRC的敏感性和特异性分别为0.36和0.71，AUC为0.66。FC对IBD的诊断准确性在儿童中高于成人，在截断值为100μg/g时比截断值为50μg/g时更准确。敏感性分析和元回归分析未显著改变结果。
不建议将FC作为普通人群CRC的筛查试验。FC在区分IBD与非IBD诊断方面似乎具有良好的诊断准确性，在截断值为100μg/g时准确性更高。
