Kennedy Nicholas A, Clark Annalie, Walkden Andrew, Chang Jeff C W, Fascí-Spurio Federica, Muscat Martina, Gordon Brydon W, Kingstone Kathleen, Satsangi Jack, Arnott Ian D R, Lees Charlie W
Gastrointestinal Unit, Western General Hospital, Edinburgh, UK.
Department of Clinical Biochemistry, Western General Hospital, Edinburgh, UK.
J Crohns Colitis. 2015 Jan;9(1):41-9. doi: 10.1016/j.crohns.2014.07.005.
Distinguishing inflammatory bowel disease (IBD) from functional gastrointestinal (GI) disease remains an important issue for gastroenterologists and primary care physicians, and may be difficult on the basis of symptoms alone. Faecal calprotectin (FC) is a surrogate marker for intestinal inflammation but not cancer.
This large retrospective study aimed to determine the most effective use of FC in patients aged 16-50 presenting with GI symptoms.
FC results were obtained for patients presenting to the GI clinics in Edinburgh between 2005 and 2009 from the Edinburgh Faecal Calprotectin Registry containing FCs from >16,000 patients. Case notes were interrogated to identify demographics, subsequent investigations and diagnoses.
895 patients were included in the main analysis, 65% female and with a median age of 33 years. 10.2% were diagnosed with IBD, 7.3% with another GI condition associated with an abnormal GI tract and 63.2% had functional GI disease. Median FC in these three groups were 1251, 50 and 20 μg/g (p < 0.0001). On ROC analysis, the AUC for FC as a predictor of IBD vs. functional disease was 0.97. Using a threshold of ≥ 50 μg/g for IBD vs. functional disease yielded a sensitivity of 0.97, specificity of 0.74, positive predictive value of 0.37 and negative predictive value of 0.99. Combined with alarm symptoms, the sensitivity was 1.00.
Implementation of FC in the initial diagnostic workup of young patients with GI symptoms, particularly those without alarm symptoms, is highly accurate in the exclusion of IBD, and can provide reassurance to patients and physicians.
区分炎症性肠病（IBD）与功能性胃肠病对胃肠病学家和初级保健医生而言仍是一个重要问题，仅依据症状可能难以区分。粪便钙卫蛋白（FC）是肠道炎症而非癌症的替代标志物。
这项大型回顾性研究旨在确定FC在16至50岁出现胃肠道症状患者中的最有效应用。
从爱丁堡粪便钙卫蛋白登记处获取2005年至2009年在爱丁堡胃肠病诊所就诊患者的FC结果，该登记处包含超过16000名患者的FC数据。查阅病例记录以确定人口统计学信息、后续检查及诊断情况。
895名患者纳入主要分析，其中65%为女性，中位年龄33岁。10.2%被诊断为IBD，7.3%患有与胃肠道异常相关的其他胃肠疾病，63.2%患有功能性胃肠病。这三组的中位FC分别为1251、50和20μg/g（p<0.0001）。经ROC分析，FC作为IBD与功能性疾病预测指标的AUC为0.97。以≥50μg/g作为IBD与功能性疾病的阈值，敏感性为0.97，特异性为0.74，阳性预测值为0.37，阴性预测值为0.99。结合报警症状，敏感性为1.00。
在对有胃肠道症状的年轻患者，尤其是无报警症状的患者进行初始诊断检查时应用FC，在排除IBD方面具有高度准确性，可为患者和医生提供安心的依据。
