粪便钙卫蛋白水平低可预测炎症性肠病患者的持续临床缓解：呼吁深度缓解。
Low fecal calprotectin predicts sustained clinical remission in inflammatory bowel disease patients: a plea for deep remission.
机构信息
University Medical Center Utrecht, Department of Gastroenterology and Hepatology, Utrecht, Netherlands.
University Medical Center Utrecht, Department of Pathology, Utrecht, Netherlands.
出版信息
J Crohns Colitis. 2015 Jan;9(1):50-5. doi: 10.1093/ecco-jcc/jju003. Epub 2014 Nov 26.
BACKGROUND AND AIMS
Mucosal healing has become the treatment goal in patients with ulcerative colitis (UC) and Crohn's disease (CD). Whether low fecal calprotectin levels and histological healing combined with mucosal healing is associated with a further reduced risk of relapses is unknown.
METHODS
Patients with CD, UC or inflammatory bowel disease-unclassified (IBD-U) scheduled for surveillance colonoscopy collected a stool sample prior to bowel cleansing. Only patients with mucosal healing (MAYO endoscopic score of 0) were included. Fecal calprotectin was measured using a quantitative enzyme-linked immunosorbent assay (R-Biopharm, Germany). Biopsies were obtained from four colonic segments, and histological disease severity was assessed using the Geboes scoring system. Patients were followed until the last outpatient clinic visit or the development of a relapse, which was defined as IBD-related hospitalization, surgery or step-up in IBD medication.
RESULTS
Of the 164 patients undergoing surveillance colonoscopy, 92 patients were excluded due to active inflammation or missing biopsies. Of the remaining 72 patients (20 CD, 52 UC or IBD-U), six patients (8%) relapsed after a median follow-up of 11 months (range 5-15 months). Median fecal calprotectin levels at baseline were significantly higher for patients who relapsed compared with patients who maintained remission (284 mg/kg vs. 37 mg/kg. p < 0.01). Fecal calprotectin below 56 mg/kg was found to optimally predict absence of relapse during follow-up with 64% sensitivity, 100% specificity, 100% negative predictive value and 20% positive predictive value. The presence or absence of active inflammation determined by Geboes cut-off score of 3.1 was less strongly associated with the risk of relapse (64% sensitivity, 33% specificity, 9% negative predictive value and 92% positive predictive value.
CONCLUSION
Low calprotectin levels identify IBD patients who remain in stable remission during follow-up.
背景与目的
黏膜愈合已成为溃疡性结肠炎（UC）和克罗恩病（CD）患者的治疗目标。粪便钙卫蛋白水平低且组织学愈合与黏膜愈合相结合是否与进一步降低复发风险有关尚不清楚。
方法
接受监测性结肠镜检查的 CD、UC 或炎症性肠病未分类（IBD-U）患者在肠道清洁前采集粪便样本。仅纳入黏膜愈合（MAYO 内镜评分 0 分）的患者。采用定量酶联免疫吸附试验（R-Biopharm，德国）测量粪便钙卫蛋白。从四个结肠段获取活检标本，并使用 Geboes 评分系统评估组织学疾病严重程度。患者随访至最后一次门诊就诊或出现复发，复发定义为与 IBD 相关的住院、手术或 IBD 药物升级。
结果
在接受监测性结肠镜检查的 164 例患者中，92 例因活动性炎症或缺失活检而被排除。在剩余的 72 例患者（20 例 CD、52 例 UC 或 IBD-U）中，6 例（8%）在中位随访 11 个月（5-15 个月）后复发。与维持缓解的患者相比，复发患者的基线粪便钙卫蛋白水平中位数显著更高（284 mg/kg 比 37 mg/kg，p<0.01）。粪便钙卫蛋白<56 mg/kg 可最佳预测随访期间无复发，其灵敏度为 64%、特异性为 100%、阴性预测值为 100%和阳性预测值为 20%。Geboes 截断值 3.1 确定的是否存在活动性炎症与复发风险的相关性较弱（灵敏度为 64%、特异性为 33%、阴性预测值为 9%和阳性预测值为 92%）。
结论
低钙卫蛋白水平可识别出在随访期间保持稳定缓解的 IBD 患者。
Zotero 插件