Department of Gastroenterology, Hospital Universitari de Bellvitge-Institut d'Investigació Biomédica de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.
Department of Gastroenterology, Hospital Universitari de Bellvitge-Institut d'Investigació Biomédica de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.
Clin Gastroenterol Hepatol. 2014 Nov;12(11):1865-70. doi: 10.1016/j.cgh.2014.06.020. Epub 2014 Jun 30.
BACKGROUND & AIMS: Histologic recovery of patients with ulcerative colitis (UC) often is incomplete, even among those in clinical and endoscopic remission. Persistent active microscopic inflammation is associated with an increased risk of relapse and colorectal neoplasia. A high level of fecal calprotectin (FC) is a reliable marker of endoscopic lesions in patients with UC. We evaluated the accuracy of FC in identifying patients with UC in clinical and endoscopic remission who still have histologic features of inflammation.
We performed a prospective observational study of 59 patients with UC in clinical and endoscopic remission undergoing colonoscopy. Several biopsy specimens were collected from each colonic segment. Endoscopic remission was defined as a Mayo endoscopic subscore with a grade of 0 or 1. Active histologic inflammation was defined by the presence of neutrophils infiltrating crypt epithelial cells. FC was determined by enzyme-linked immunosorbent assay analysis.
Eighteen patients (30.5%) showed evidence of active histologic inflammation. Patients with active histologic inflammation had a significantly higher median level of FC (278 μg/g; interquartile range, 136-696 μg/g) than those without active histologic inflammation (68 μg/g; interquartile range, 30-172 μg/g) (P = .002). In multivariate analysis, the FC and Mayo endoscopic subscore (0 or 1) were each independent predictors of histologic inflammation. The level of FC identified active histologic inflammation in patients in clinical and endoscopic remission, with an area under the receiver operator characteristic curve value of 0.754.
Histologic inflammation is common among patients with UC in clinical and endoscopic remission. Patients with histologic features of inflammation can be identified reliably based on their fecal level of calprotectin.
溃疡性结肠炎（UC）患者的组织学恢复常常不完全，即使在临床和内镜缓解的患者中也是如此。持续存在的显微镜下炎症活动与复发和结直肠肿瘤的风险增加相关。粪便钙卫蛋白（FC）水平高是 UC 患者内镜下病变的可靠标志物。我们评估了 FC 识别临床和内镜缓解但仍存在组织学炎症特征的 UC 患者的准确性。
我们对 59 例临床和内镜缓解的 UC 患者进行了前瞻性观察性研究，这些患者接受了结肠镜检查。每个结肠节段采集了多个活检标本。内镜缓解定义为 Mayo 内镜亚评分 0 或 1 级。组织学炎症活动定义为隐窝上皮细胞中有中性粒细胞浸润。通过酶联免疫吸附分析测定 FC。
18 例患者（30.5%）存在组织学炎症活动的证据。有组织学炎症活动的患者 FC 中位数水平明显更高（278 μg/g；四分位距 136-696 μg/g），而无组织学炎症活动的患者 FC 中位数水平较低（68 μg/g；四分位距 30-172 μg/g）（P =.002）。在多变量分析中，FC 和 Mayo 内镜亚评分（0 或 1）均是组织学炎症的独立预测因素。FC 可识别临床和内镜缓解的患者中的组织学炎症，受试者工作特征曲线下面积为 0.754。
在临床和内镜缓解的 UC 患者中，组织学炎症很常见。基于粪便 FC 水平，可可靠地识别出具有炎症组织学特征的患者。
