Jensen Michael Dam, Kjeldsen Jens, Nathan Torben
Department of Internal Medicine, Section of Gastroenterology, Lillebaelt Hospital Vejle, Vejle, Denmark.
Scand J Gastroenterol. 2011 Jun;46(6):694-700. doi: 10.3109/00365521.2011.560680. Epub 2011 Apr 1.
The utility of fecal calprotectin (fCal) in small bowel Crohn's disease (CD) remains to be clarified. The primary aim of this study was to determine levels of fCal in CD restricted to the small bowel compared with CD affecting the colon, in patients undergoing their first diagnostic work-up. In addition, the study assessed the sensitivity and specificity of fCal in suspected CD.
A total of 83 patients referred to gastroenterology out-patient clinic with suspected CD were included in this prospective, blinded study, and fCal was measured during diagnostic work-up. Ileo-colonoscopy + capsule endoscopy/surgery (n = 81), ileo-colonoscopy + upper endoscopy (n = 1), and ileo-colonoscopy (n = 1) served as gold standard for the presence and location of CD.
A total of 40 patients were diagnosed with CD: small bowel 13, colonic 16, and ileo-colonic 11. Levels of fCal were equal in patients with small bowel or colonic CD: median 890 mg/kg and 830 mg/kg, respectively (p = 1.0). With a 50 mg/kg cut-off, CD in the small intestine and colon was diagnosed with 92% and 94% sensitivities, respectively, and the overall sensitivity and specificity of fCal was 95% and 56%. In this cohort, CD was ruled out with a negative predictive value of 92%.
This is the first study to show that fCal is equally sensitive in colonic and small bowel CD. In patients suspected of CD, fCal is an effective marker to rule out this diagnosis and select patients for endoscopy.
粪便钙卫蛋白（fCal）在小肠克罗恩病（CD）中的作用仍有待阐明。本研究的主要目的是确定在首次接受诊断检查的患者中，局限于小肠的CD患者与累及结肠的CD患者的fCal水平。此外，本研究评估了fCal在疑似CD中的敏感性和特异性。
本前瞻性、盲法研究纳入了83例因疑似CD转诊至胃肠病门诊的患者，并在诊断检查期间测量了fCal。回结肠镜检查+胶囊内镜/手术（n = 81）、回结肠镜检查+上消化道内镜检查（n = 1）以及回结肠镜检查（n = 1）作为CD存在和部位的金标准。
共有40例患者被诊断为CD：小肠型13例，结肠型16例，回结肠型11例。小肠或结肠CD患者的fCal水平相当：中位数分别为890 mg/kg和830 mg/kg（p = 1.0）。以50 mg/kg为临界值，小肠和结肠CD的诊断敏感性分别为92%和94%，fCal的总体敏感性和特异性分别为95%和56%。在该队列中，fCal阴性预测值为92%可排除CD。
这是第一项表明fCal在结肠和小肠CD中敏感性相同的研究。在疑似CD的患者中，fCal是排除该诊断并选择患者进行内镜检查的有效标志物。
