*Department of Gastroenterology, Hospices Civils de Lyon and University Claude Bernard Lyon 1, Lyon, France; †INSERM U1111 (CIRI), Lyon, France; ‡Cisbio Bioassays, Bagnols sur Cèze, France; and §Laboratory of Biochemistry, LyonSud Hospital, Pierre-Benite, France.
Inflamm Bowel Dis. 2015 Feb;21(2):331-6. doi: 10.1097/MIB.0000000000000273.
Calprotectin and S100A12 (calgranulin C) are markers of gut inflammation. The aim was to compare the usefulness of serum and fecal calprotectin (fCal) and S100A12 in assessing the response to anti-TNF and in predicting relapse under maintenance therapy in Crohn's diseases (CD).
Thirty-two consecutive patients with CD were treated with adalimumab or infliximab. All received an induction regimen followed by maintenance therapy with infliximab 5 mg/kg every 8 weeks or adalimumab 40 mg every other week and provided at week 0 and 14 fecal and blood samples for determination serum CRP, serum and fecal calprotectin and S100A12 levels.
Clinical remission at week 14 (responders) was achieved in 21 patients and among them, 12 were still in steroid-free clinical remission at week 52. Median serum S100A12 and fCal concentrations significantly drop only in responders from week 0 to week 14 after induction, whereas serum calprotectin and fecal S100A12 levels failed to differ significantly. Fecal calprotectin levels at week 14 had the highest discriminant validity to predict clinical remission within 1 year after induction (area under the curve = 0.87) followed by fecal, serum S100A12, and serum calprotectin (area under the ROC curve = 0.70, 0.70, and 0.68, respectively). A cutoff of 82 μg/g for fCal at week 14 had a sensitivity and specificity of 93% and 75%, respectively, to predict clinical remission within 1 year of therapy.
Serum S100A12 level and fCal are reliable markers associated with response to induction therapy with anti-TNF. Fecal calprotectin was the best for predicting clinical remission in CD under maintenance therapy.
钙卫蛋白和 S100A12（钙粒蛋白 C）是肠道炎症的标志物。本研究旨在比较血清和粪便钙卫蛋白（fCal）与 S100A12 在评估抗 TNF 反应和预测克罗恩病（CD）维持治疗中复发的作用。
32 例连续 CD 患者接受阿达木单抗或英夫利昔单抗治疗。所有患者均接受诱导治疗，然后用英夫利昔单抗 5mg/kg 每 8 周或阿达木单抗 40mg 每两周维持治疗，并在第 0 周和第 14 周提供粪便和血液样本，用于检测血清 CRP、血清和粪便钙卫蛋白和 S100A12 水平。
第 14 周达到临床缓解（应答者）的有 21 例，其中 12 例在第 52 周时仍处于无激素的临床缓解。仅在诱导后第 0 周到第 14 周，应答者的血清 S100A12 和 fCal 浓度中位数显著下降，而血清钙卫蛋白和粪便 S100A12 水平无显著差异。第 14 周时的粪便钙卫蛋白水平对预测诱导后 1 年内的临床缓解具有最高的判别有效性（曲线下面积=0.87），其次是粪便、血清 S100A12 和血清钙卫蛋白（ROC 曲线下面积=0.70、0.70 和 0.68）。第 14 周时 fCal 的截断值为 82μg/g 时，对预测治疗 1 年内的临床缓解具有 93%的敏感性和 75%的特异性。
血清 S100A12 水平和 fCal 是与抗 TNF 诱导治疗反应相关的可靠标志物。在 CD 维持治疗中，粪便钙卫蛋白是预测临床缓解的最佳指标。
