Walker Thomas R, Land Michelle L, Kartashov Alex, Saslowsky Tracee M, Lyerly David M, Boone James H, Rufo Paul A
Center for Inflammatory Bowel Disease, Harvard Medical School, Boston, MA, USA.
J Pediatr Gastroenterol Nutr. 2007 Apr;44(4):414-22. doi: 10.1097/MPG.0b013e3180308d8e.
Fecal lactoferrin (FLA) is a neutrophil-derived surrogate marker of intestinal inflammation that is elevated in patients with inflammatory bowel disease. However, the correlation between FLA levels and serological markers of disease activity has not been previously reported, to our knowledge. In the present study we evaluated the ability of FLA levels to reflect disease activity in pediatric patients with inflammatory bowel disease. We further assessed the relationship between FLA levels and customary laboratory and clinical measures of inflammation.
Fecal specimens were collected from 148 consecutive pediatric patients (79 with Crohn disease, 62 with ulcerative colitis, and 7 with irritable bowel syndrome) and 22 healthy control individuals. Lactoferrin was measured by enzyme-linked immunosorbent assay (IBD-SCAN, TECHLAB, Inc). Disease activity was assessed at the time of sample provision by laboratory measures (including erythrocyte sedimentation rate [ESR] and albumin) and previously validated disease activity indices (Pediatric Crohn Disease Activity Index, Kozarek, Harvey Bradshaw Activity Index).
Lactoferrin levels were significantly higher in patients with ulcerative colitis (1880 +/- 565 microg/mL) (mean +/- SE) or Crohn disease (1701 +/- 382 microg/mL) than in healthy control individuals under 21 years of age (1.17 +/- 0.47 microg/mL, P < 0.001). Lactoferrin levels correlated significantly with ESR, hematocrit, albumin, and platelet count (P < 0.001). Receiver operating characteristic curve analysis revealed that FLA levels were comparable to ESR in detecting patients with clinically active disease (P < 0.001). Patients who experienced a clinical flare within 2 months of specimen collection displayed higher lactoferrin levels (845 +/- 452 microg/mL) than did those who remained in clinical remission (190 +/- 90 microg/mL, P = 0.003).
Data presented here demonstrate that FLA is a sensitive and specific biochemical marker of inflammation for use in the diagnosis and interval assessment of pediatric patients with IBD, and its level correlates well with both clinical disease activity indices and ESR. Elevated levels of FLA may also identify patients at greater risk for the development of subsequent clinical flares.
粪便乳铁蛋白（FLA）是一种源自中性粒细胞的肠道炎症替代标志物，在炎症性肠病患者中升高。然而，据我们所知，FLA水平与疾病活动的血清学标志物之间的相关性此前尚未见报道。在本研究中，我们评估了FLA水平反映小儿炎症性肠病患者疾病活动的能力。我们还进一步评估了FLA水平与常规实验室及临床炎症指标之间的关系。
收集了148例连续的小儿患者（79例克罗恩病、62例溃疡性结肠炎和7例肠易激综合征）以及22例健康对照个体的粪便标本。采用酶联免疫吸附测定法（IBD - SCAN，TECHLAB公司）检测乳铁蛋白。在提供样本时，通过实验室检测指标（包括红细胞沉降率[ESR]和白蛋白）以及先前验证的疾病活动指数（小儿克罗恩病活动指数、科扎雷克、哈维·布拉德肖活动指数）评估疾病活动情况。
溃疡性结肠炎患者（1880±565μg/mL）（均值±标准误）或克罗恩病患者（1701±382μg/mL）的乳铁蛋白水平显著高于21岁以下的健康对照个体（1.17±0.47μg/mL，P<0.001）。乳铁蛋白水平与ESR、血细胞比容、白蛋白和血小板计数显著相关（P<0.001）。受试者工作特征曲线分析显示，在检测临床活动期疾病患者方面，FLA水平与ESR相当（P<0.001）。在标本采集后2个月内出现临床病情加重的患者，其乳铁蛋白水平（845±452μg/mL）高于病情持续缓解的患者（190±90μg/mL，P = 0.003）。
此处呈现的数据表明，FLA是用于小儿炎症性肠病诊断和期间评估的一种敏感且特异的炎症生化标志物，其水平与临床疾病活动指数及ESR均具有良好的相关性。FLA水平升高也可能识别出后续发生临床病情加重风险更高的患者。
