Gecse Krisztina B, Brandse Johannan F, van Wilpe Sandra, Löwenberg Mark, Ponsioen Cyriel, van den Brink Gijs, D'Haens Geert
Department of Gastroenterology and Hepatology, Academic Medical Centre, University of Amsterdam , Meibergdreef 9, 1105 AZ Amsterdam , The Netherlands.
Scand J Gastroenterol. 2015 Jul;50(7):841-7. doi: 10.3109/00365521.2015.1008035. Epub 2015 Jan 30.
The correlation between the Simple Endoscopic Score for Crohn's Disease (SES-CD) and fecal calprotectin is well established in (ileo)colonic Crohn's disease (CD). However, for ileal CD, existing data are conflicting. The aim of this study is to evaluate the biomarker profile in CD patients with varying severity and location of mucosal ulceration.
An electronic patient database search identified CD patients in whom ileocolonoscopy, fecal calprotectin (CALPRO), serum C-reactive protein (CRP) and blood leukocyte counts (LEU) were measured within a 4-week interval without changes in medication. Ileocolonoscopies were scored for the presence of ulcers in each segment as defined by the SES-CD and the sum of segmental ulcer scores resulted in a partial SES-CD (pSES-CD).
Fourty-four patients were identified, of whom 9/44 had ileal CD, 20/44 colonic and 15/44 ileocolonic CD based on the Montreal classification. In the total study population CALPRO correlated best with pSES-CD (r = 0.76, p < 0.0001), followed by LEU (r = 0.54, p = 0.0004) and CRP (r = 0.45, p = 0.0026). Patients with ileal CD had significantly lower CALPRO level than those with (ileo)colonic disease even in the presence of large and/or very large ulcers (mean ± SEM: 297 ± 81 μg/g vs. 1523 ± 97 μg/g, p < 0.0001). LEU was also significantly lower in the presence of large and/or very large ulcers in ileal CD compared to those with (ileo)colonic disease (mean ± SEM: 6.7 ± 0.9 × 10(9)/l vs. 10.6 ± 0.8 × 10(9)/l, p = 0.02). A similar trend was identified regarding CRP levels.
Even in the presence of large or very large ulcers, patients with ileal Crohn's may not have markedly elevated fecal calprotectin levels.
在（回）结肠克罗恩病（CD）中，克罗恩病简易内镜评分（SES-CD）与粪便钙卫蛋白之间的相关性已得到充分证实。然而，对于回肠CD，现有数据存在矛盾。本研究的目的是评估不同严重程度和黏膜溃疡部位的CD患者的生物标志物谱。
通过电子患者数据库搜索，确定在4周内进行了回结肠镜检查、测量了粪便钙卫蛋白（CALPRO）、血清C反应蛋白（CRP）和血白细胞计数（LEU）且未改变用药的CD患者。根据SES-CD对回结肠镜检查中每个节段的溃疡情况进行评分，节段溃疡评分总和即为部分SES-CD（pSES-CD）。
共确定44例患者，根据蒙特利尔分类，其中9/44为回肠CD，20/44为结肠CD，15/44为回结肠CD。在整个研究人群中，CALPRO与pSES-CD的相关性最佳（r = 0.76，p < 0.0001），其次是LEU（r = 0.54，p = 0.0004）和CRP（r = 0.45，p = 0.0026）。即使存在大溃疡和/或非常大的溃疡，回肠CD患者的CALPRO水平仍显著低于（回）结肠疾病患者（均值±标准误：297±81μg/g vs. 1523±97μg/g，p < 0.0001）。与（回）结肠疾病患者相比，回肠CD患者在存在大溃疡和/或非常大的溃疡时，LEU也显著降低（均值±标准误：6.7±0.9×10⁹/l vs. 10.6±0.8×10⁹/l，p = 0.02）。CRP水平也呈现类似趋势。
即使存在大溃疡或非常大的溃疡，回肠克罗恩病患者的粪便钙卫蛋白水平可能也不会显著升高。
