Bodelier Alexander G L, Pierik Marieke J, van den Heuvel Tim, Bovee-Oudenhoven Ingeborg M J, de Boer Evelien, Hameeteman Wim, Masclee Ad A M, Jonkers Daisy
aDivision of Gastroenterology and Hepatology, Maastricht University Medical Center bTI Food and Nutrition, Wageningen cNIZO food research, Ede dDivision of Internal Medicine & Gastroenterology, Amphia Hospital Breda, Breda, The Netherlands.
Eur J Gastroenterol Hepatol. 2014 Aug;26(8):902-9. doi: 10.1097/MEG.0000000000000141.
Monitoring of mucosal inflammation in inflammatory bowel disease (IBD) is of major importance. New noninvasive markers for intestinal inflammation are needed. Previous studies have reported that pancreatitis-associated protein (PAP) correlates with clinical activity in IBD subgroups. Our aim was to investigate the correlation of serum and fecal PAP with clinical and biochemical parameters of disease activity in a real-life IBD cohort.
Two hundred and five consecutive IBD patients were enrolled. Clinical disease activity was scored by the Harvey-Bradshaw Index or the Simple Clinical Colitis Activity Index; also, C-reactive protein (CRP), erythrocyte sedimentation rate, and fecal calprotectin were determined. As surrogate for endoscopy, a combination score of clinical indices with CRP or calprotectin was used to define active disease. Fecal and serum PAP were measured by ELISA.
The median serum and fecal PAP did not differ in Crohn's disease (CD) or ulcerative colitis (UC) patients with active compared with inactive disease according to clinical activity indices. Defining active disease by a combination score of Harvey-Bradshaw Index of more than 4 and CRP of more than 5 mg/l or calprotectin more than 250 µg/g, serum PAP (P=0.01), but not fecal PAP (P=0.32), was significantly higher in active than inactive CD patients. Area under the curve of the corresponding receiver operating curve (ROC) was 0.64. No differences were found in serum or fecal PAP levels using the combination score for active disease in UC.
Serum but not fecal PAP was higher in active compared with nonactive CD and may reflect mucosal inflammation in CD, but not in UC. However, the accuracy of serum PAP for the diagnosis of active disease was poor, and therefore, serum PAP does not seem to have additional value compared with the current noninvasive markers.
监测炎症性肠病（IBD）中的黏膜炎症至关重要。需要新的肠道炎症非侵入性标志物。既往研究报道，胰腺炎相关蛋白（PAP）与IBD亚组的临床活动相关。我们的目的是在一个真实世界的IBD队列中研究血清和粪便PAP与疾病活动的临床及生化参数之间的相关性。
纳入205例连续的IBD患者。采用哈维-布拉德肖指数或简单临床结肠炎活动指数对临床疾病活动进行评分；同时，测定C反应蛋白（CRP）、红细胞沉降率和粪便钙卫蛋白。作为内镜检查的替代指标，使用临床指标与CRP或钙卫蛋白的综合评分来定义活动性疾病。采用酶联免疫吸附测定法检测粪便和血清PAP。
根据临床活动指数，与非活动性疾病的克罗恩病（CD）或溃疡性结肠炎（UC）患者相比，活动性疾病患者的血清和粪便PAP中位数无差异。采用哈维-布拉德肖指数大于4且CRP大于5mg/l或钙卫蛋白大于250μg/g的综合评分来定义活动性疾病时，活动性CD患者的血清PAP（P=0.01）显著高于非活动性患者，而粪便PAP（P=0.32）无显著差异。相应的受试者工作特征曲线（ROC）下面积为0.64。在UC中，使用活动性疾病综合评分时，血清或粪便PAP水平无差异。
与非活动性CD相比，活动性CD患者的血清PAP而非粪便PAP更高，血清PAP可能反映CD中的黏膜炎症，但不能反映UC中的黏膜炎症。然而，血清PAP诊断活动性疾病的准确性较差，因此，与目前的非侵入性标志物相比，血清PAP似乎没有额外价值。
