Can J Gastroenterol Hepatol. 2015 May;29(4):203-8. doi: 10.1155/2015/389548.
There is increasing interest in the concept of 'treat-to-target' in inflammatory bowel disease as a mechanism to standardize management and prevent complications. While clinical, radiographic and endoscopic treatment end points will figure prominently in this promising management paradigm, the role that noninvasive biomarkers will play is currently undefined. The goal of the present systematic review was to investigate the potential value of biomarkers as treatment targets in inflammatory bowel disease, with particular focus on those best studied: serum C-reactive protein (CRP) and fecal calprotectin. In Crohn disease, elevated CRP levels at baseline predict response to anti-tumour necrosis factor agents, and normalization is usually associated with clinical and endoscopic remission. CRP and hemoglobin levels can be used to help predict clinical relapse in the context of withdrawal of therapy. Ultimately, the authors conclude that currently available biomarkers should not be used as treatment targets in inflammatory bowel disease because they have inadequate operational characteristics to make them safe surrogates for clinical, endoscopic and radiographic evaluation. However, CRP and fecal calprotectin are important adjunctive measures that help alert the clinician to pursue further investigation.
人们对炎症性肠病的“靶向治疗”概念越来越感兴趣，因为它是一种规范管理和预防并发症的机制。虽然临床、影像学和内镜治疗终点将在这一有前途的管理模式中占据重要地位，但目前尚不清楚非侵入性生物标志物将发挥什么作用。本系统评价的目的是研究生物标志物作为炎症性肠病治疗靶点的潜在价值，特别关注研究最多的标志物：血清 C 反应蛋白（CRP）和粪便钙卫蛋白。在克罗恩病中，基线时升高的 CRP 水平可预测对抗肿瘤坏死因子药物的反应，而通常与临床和内镜缓解相关的是 CRP 水平正常化。CRP 和血红蛋白水平可用于帮助预测在停止治疗的情况下的临床复发。最终，作者得出结论，目前可用的生物标志物不应作为炎症性肠病的治疗靶点，因为它们的操作特性不足，不能作为临床、内镜和影像学评估的安全替代指标。然而，CRP 和粪便钙卫蛋白是重要的辅助措施，可以提醒临床医生进一步进行检查。
