Maria Helsinki City Hospital and University of Helsinki, Helsinki, Finland.
Inflamm Bowel Dis. 2012 Nov;18(11):2011-7. doi: 10.1002/ibd.22863. Epub 2012 Jan 4.
Fecal calprotectin (FC) concentration is a useful surrogate marker for mucosal healing (MH) during tumor necrosis factor alpha (TNFα)-blocking therapy for inflammatory bowel disease (IBD). Our aim was to evaluate whether a normal FC after induction therapy with TNFα antagonist predicts the outcome of IBD patients during maintenance therapy.
Sixty IBD patients (34 Crohn's disease [CD], 26 ulcerative colitis [UC]), treated with TNFα antagonists, either infliximab (n = 42) or adalimumab (n = 18), and having a documented FC level at baseline and after induction therapy were included. Disease activity was evaluated by partial Mayo score without endoscopy or Harvey-Bradshaw index at baseline, after induction, and at 12 months during maintenance therapy.
After induction, FC was normalized (≤ 100 μg/g) in 31 patients (52%, median 42 μg/g, range 0-97), whereas the level remained elevated in 29 patients (48%, median 424 μg/g, range 116-5859). At ≈12 months, 26/31 (84%, 18 CD, 8 UC) of the patients with normal FC after induction were in clinical remission, whereas only 11/29 (38%, 9 CD, 2 UC) of those with an elevated (≥ 100 μg/g) postinduction FC were in clinical remission, P < 0.0001. After induction therapy with TNFα antagonists, a cutoff concentration of 139 μg/g for FC had a sensitivity of 72% and a specificity of 80% to predict a risk of clinically active disease after 1 year.
A normal FC after induction therapy with TNFα antagonists predicts sustained clinical remission in the majority of patients on scheduled therapy with active luminal disease.
粪便钙卫蛋白（FC）浓度是肿瘤坏死因子-α（TNFα）阻断治疗炎症性肠病（IBD）时黏膜愈合（MH）的有用替代标志物。我们的目的是评估诱导治疗后 TNFα 拮抗剂的 FC 正常是否预测 IBD 患者维持治疗期间的结局。
纳入 60 例接受 TNFα 拮抗剂（英夫利昔单抗[n = 42]或阿达木单抗[n = 18]）治疗的 IBD 患者（34 例克罗恩病[CD]，26 例溃疡性结肠炎[UC]），且基线和诱导治疗后均有 FC 水平记录。在基线、诱导后和维持治疗的 12 个月时，通过内镜下无部分 Mayo 评分或 Harvey-Bradshaw 指数评估疾病活动度。
诱导后，31 例（52%，中位数 42 μg/g，范围 0-97）患者 FC 正常（≤100 μg/g），而 29 例（48%，中位数 424 μg/g，范围 116-5859）患者 FC 仍升高。在约 12 个月时，诱导后 FC 正常的 26/31 例（84%，18 例 CD，8 例 UC）患者处于临床缓解，而 FC 升高（≥100 μg/g）的 29/29 例（38%，9 例 CD，2 例 UC）患者中仅有 11 例处于临床缓解，P <0.0001。TNFα 拮抗剂诱导治疗后，FC 的截断浓度为 139 μg/g 时，预测 1 年后临床活动性疾病的风险具有 72%的敏感性和 80%的特异性。
TNFα 拮抗剂诱导治疗后 FC 正常可预测大多数接受积极肠道疾病维持治疗的患者持续临床缓解。
