粪便钙卫蛋白和乳铁蛋白作为监测克罗恩病患者回肠结肠切除术后疾病活动度和预测临床复发的标志物：一项前瞻性试点研究。
Faecal calprotectin and lactoferrin as markers for monitoring disease activity and predicting clinical recurrence in patients with Crohn's disease after ileocolonic resection: A prospective pilot study.
机构信息
Inflammatory Bowel Disease Centre, Yokkaichi Social Insurance Hospital, Yokkaichi, Mie, Japan.
出版信息
United European Gastroenterol J. 2013 Oct;1(5):368-74. doi: 10.1177/2050640613501818.
BACKGROUND
Several studies have reported that faecal calprotectin and lactoferrin showed a close correlation with endoscopic inflammation in patients with inflammatory bowel disease. However, the clinical significance of faecal calprotectin or lactoferrin in postoperative Crohn's disease (CD) is not fully evaluated. This prospective study was to investigate the relationship between endoscopic activity, and faecal calprotectin and lactoferrin, and assess the predictive value of these markers for future recurrence.
METHODS
Twenty patients who remained in remission during 6-12 months after ileocolonic resection for CD were included. All patients underwent ileocolonoscopy for assessing endoscopic activity (Rutgeerts score) in the neo-terminal ileum. A stool sample was collected for measurement of calprotectin and lactoferrin. All patients were then followed up for 12 months, and clinical recurrence was defined as a CDAI >150 with an increase of ≥70 points.
RESULTS
The mean time between surgery and the endoscopic examination at entry was 7.2 months. The endoscopic scores were i0 or i1 in 10 patients, i2 in six patients, i3 in three patients, and i4 in one patient. Both calprotectin and lactoferrin positively correlated with the endoscopic scores (p = 0.0001 and p = 0.038, respectively). Six patients developed clinical recurrence during the 12-month follow-up. Both calprotectin and lactoferrin levels were significantly higher in patients with clinical recurrence than those in remission (p = 0.0007 and p = 0.025, respectively). A cutoff value of 170 µg/g for calprotectin had a sensitivity of 83% and a specificity of 93% to predict a risk of clinical recurrence, while a cutoff value of 140 µg/g for lactoferrin had a sensitivity of 67% and a specificity of 71%.
CONCLUSIONS
Both calprotectin and lactoferrin levels correlate well with endoscopic activity after ileocolonic resection for CD. Calprotectin and lactoferrin could be clinically relevant biomarkers for predicting postoperative recurrence. Further well-designed large trials should strengthen the findings of the present investigation.
背景
几项研究表明，粪便钙卫蛋白和乳铁蛋白与炎症性肠病患者的内镜下炎症密切相关。然而，粪便钙卫蛋白或乳铁蛋白在术后克罗恩病（CD）中的临床意义尚未得到充分评估。本前瞻性研究旨在探讨内镜活动与粪便钙卫蛋白和乳铁蛋白之间的关系，并评估这些标志物对未来复发的预测价值。
方法
纳入 20 例在接受回肠结肠切除术治疗 CD 后 6-12 个月内处于缓解期的患者。所有患者均行回结肠镜检查，评估新末端回肠的内镜活动（Rutgeerts 评分）。采集粪便样本测量钙卫蛋白和乳铁蛋白。所有患者随后进行 12 个月的随访，临床复发定义为 CDAI>150 且增加≥70 分。
结果
手术与入组时内镜检查的平均时间为 7.2 个月。10 例患者内镜评分 i0 或 i1，6 例患者 i2，3 例患者 i3，1 例患者 i4。钙卫蛋白和乳铁蛋白与内镜评分均呈正相关（p=0.0001 和 p=0.038）。12 个月随访期间，6 例患者发生临床复发。临床复发患者的钙卫蛋白和乳铁蛋白水平均显著高于缓解期患者（p=0.0007 和 p=0.025）。钙卫蛋白的截断值为 170µg/g 时，预测临床复发的敏感性为 83%，特异性为 93%；乳铁蛋白的截断值为 140µg/g 时，敏感性为 67%，特异性为 71%。
结论
回肠结肠切除术后，钙卫蛋白和乳铁蛋白水平与内镜活动密切相关。钙卫蛋白和乳铁蛋白可能是预测术后复发的有临床意义的生物标志物。需要进一步进行精心设计的大型试验来加强本研究的发现。
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