Department of Gastroenterology, University Medical Clinic, Cantonal Hospital, Rheinstrasse 24, 4410, Liestal, Switzerland,
Dig Dis Sci. 2015 Feb;60(2):485-91. doi: 10.1007/s10620-014-3383-0. Epub 2014 Oct 26.
Non-invasive monitoring of inflammatory bowel disease is an unmet clinical need as patients in clinical remission may have residual mucosal inflammation preceding clinical relapse.
We aimed to assess the value of fecal calprotectin and standardized clinical activity scoring to monitor disease activity in ulcerative colitis under medical treatment.
Forty-one patients with ulcerative colitis were included in a prospective observational study. Medical treatment was guided by clinical judgement of treating physicians. Fecal calprotectin and the clinical activity index (CAI) were measured blinded to treating physicians every 2 months until the end of follow-up. Twenty-six patients received colonoscopy for clinical reason.
As defined by the CAI, patients were in clinical remission (63.4 %), having mild (26.8 %) or moderate (11.2 %) disease activity. Of those in clinical remission (CAI ≤ 4), 86.4 % showed residual endoscopic activity (Mayo Score ≥1). Calprotectin levels were higher in endoscopically active disease (779.0 vs 331.5 μg/g, P = 0.034) and calprotectin testing identified more patients with endoscopic disease activity (86.4 %) than the CAI (45.5 %, P = 0.034). Medical treatment was escalated in 90.2 % during the study. Values of the CAI and calprotectin correlated with therapy escalation (OR 3.94 and 3.22, respectively). Only for calprotectin, changes between two measurements were related to intensified medical treatment (OR 1.39).
Fecal calprotectin was similarly useful to the CAI to monitor disease activity of ulcerative colitis during medical treatment but identified endoscopic disease activity far more reliably. Changes of calprotectin values between measurements might indicate clinical relapse earlier than the CAI.
非侵入性监测炎症性肠病是一种未满足的临床需求，因为处于临床缓解期的患者可能在临床复发前存在残留的黏膜炎症。
我们旨在评估粪便钙卫蛋白和标准化临床活动评分在药物治疗下监测溃疡性结肠炎疾病活动的价值。
41 例溃疡性结肠炎患者纳入前瞻性观察研究。药物治疗由治疗医生的临床判断指导。每 2 个月盲法测量粪便钙卫蛋白和临床活动指数（CAI），直至随访结束。26 例患者因临床原因接受结肠镜检查。
根据 CAI 定义，患者处于临床缓解期（63.4%），疾病活动度较轻（26.8%）或中度（11.2%）。在临床缓解期（CAI ≤ 4）的患者中，86.4%存在残留内镜活动（Mayo 评分≥1）。内镜活动性疾病的钙卫蛋白水平较高（779.0 vs 331.5 μg/g，P = 0.034），且钙卫蛋白检测比 CAI 更能识别内镜疾病活动（86.4% vs 45.5%，P = 0.034）。在研究期间，90.2%的患者进行了药物升级治疗。CAI 和钙卫蛋白的值与治疗升级相关（OR 3.94 和 3.22）。仅钙卫蛋白的两次测量值之间的变化与强化治疗相关（OR 1.39）。
粪便钙卫蛋白与 CAI 一样可用于监测药物治疗期间溃疡性结肠炎的疾病活动，但更可靠地识别内镜疾病活动。两次测量之间钙卫蛋白值的变化可能比 CAI 更早提示临床复发。
