粪便丙酮酸激酶同工酶M2与钙卫蛋白在评估小儿炎症性肠病严重程度及活动度中的比较

Comparison of fecal pyruvate kinase isoform M2 and calprotectin in assessment of pediatric inflammatory bowel disease severity and activity.

作者信息

Czub Elzbieta, Nowak Jan K, Szaflarska-Poplawska Anna, Grzybowska-Chlebowczyk Urszula, Landowski Piotr, Moczko Jerzy, Adamczak Daria, Mankowski Przemyslaw, Banasiewicz Tomasz, Plawski Andrzej, Walkowiak Jaroslaw

机构信息

Child & Mother Specialist Hospital in Poznan, Poznań, Poland.

Poznan University of Medical Sciences, Department of Pediatric Gastroenterology & Metabolic Diseases, Poznań, Poland.

出版信息

Acta Biochim Pol. 2014;61(1):99-102. Epub 2014 Mar 20.

PMID:24649481

Abstract

AIMS

Accurate assessment of inflammatory bowel disease (IBD) activity is the cornerstone of effective therapy. Fecal M2 isoform of pyruvate kinase (M2-PK) and fecal calprotectin (FC) are noninvasive markers of mucosal inflammation in IBD. The aim of this study was to compare performance of M2-PK and FC in assessment of pediatric ulcerative colitis (UC) and Crohn's disease (CD) severity and activity.

MATERIALS AND METHODS

121 patients with IBD, including 75 with UC and 46 with CD were recruited. Control group consisted of 35 healthy children (HS). Patients were assigned to groups depending on disease severity and activity. M2-PK and calprotectin concentration were determined in stool samples using ELISA. Areas under receiver operating characteristic curves (AUC) for FC and M2-PK with cut-off level at which M2-PK specificity was matching FC specificity were calculated and compared.

RESULTS

Performance of M2-PK at identifying patients with IBD, UC and CD among HS was inferior to FC. The differences in AUC were respectively: -0.10 (95% confidence interval [CI] [-0.13-(-0.06)], p<0.0001), -0.14 (95% CI [-0.19-(-0.09)], p<0.0001) and -0.03 (95% CI [-0.05-(-0.001)], p<0.02). M2-PK was inferior to FC in discriminating patients with mild UC from those with HS (AUC difference -0.23, 95% CI [-0.31-(-0.15)], p<0.0001).

CONCLUSIONS

FC reflects pediatric IBD severity and activity better than M2-PK. This difference is particularly pronounced when identifying patients with mild UC and UC in remission.

摘要

目的

准确评估炎症性肠病（IBD）活动度是有效治疗的基石。粪便丙酮酸激酶M2亚型（M2-PK）和粪便钙卫蛋白（FC）是IBD黏膜炎症的无创标志物。本研究旨在比较M2-PK和FC在评估儿童溃疡性结肠炎（UC）和克罗恩病（CD）严重程度及活动度方面的表现。

材料与方法

招募了121例IBD患者，其中75例为UC患者，46例为CD患者。对照组由35名健康儿童（HS）组成。根据疾病严重程度和活动度将患者分组。采用酶联免疫吸附测定法（ELISA）测定粪便样本中的M2-PK和钙卫蛋白浓度。计算并比较FC和M2-PK的受试者工作特征曲线下面积（AUC），其中M2-PK的截断水平与FC的特异性相匹配。

结果

在HS中，M2-PK识别IBD、UC和CD患者的表现不如FC。AUC的差异分别为：-0.10（95%置信区间[CI][-0.13-(-0.06)]，p<0.0001）、-0.14（95%CI[-0.19-(-0.09)]，p<0.0001）和-0.03（95%CI[-0.05-(-0.001)]，p<0.02）。在区分轻度UC患者和HS患者方面，M2-PK不如FC（AUC差异-0.23，95%CI[-0.31-(-0.15)]，p<0.0001）。