Pronio Annamaria, Di Filippo Annalisa R, Mariani Paola, Vestri Annarita, Montesani Chiara, Boirivant Monica
Department of General Surgery, "P. Stefanini", University "Sapienza", Italy.
Department of Medico-Surgical Sciences and Biotec, "Sapienza" University of Rome, Italy.
Rev Esp Enferm Dig. 2016 Apr;108(4):190-5. doi: 10.17235/reed.2016.4066/2015.
Pouchitis is the most common complication following proctocolectomy with ileal pouch-anal anastomosis for ulcerative colitis (UC). To provide a standardized definition of pouchitis clinical, endoscopic and histological markers were grouped and weighted in the pouch disease activity index (PDAI). However, the delay in the assessment of the final score due to the time requested for histological analysis remains the main obstacle to the index implementation in clinical practice so that the use of modified-PDAI (mPDAI) with exclusion of histologic subscore has been proposed. We tested the ability of calprotectin measurement in the pouch endoluminal content to mimic the histologic score as defined in the PDAI, the index that we adopted as gold standard for pouchitis diagnosis. Calprotectin was measured by ELISA in the pouch endoluminal content collected during endoscopy in 40 consecutive patients with J-pouch. In each patient PDAI and mPDAI were calculated and 15% of patients were erroneously classified by mPDAI. ROC analysis of calprotectin values vs. acute histological subscore ≥ 3 identified different calprotectin cut-off values with corresponding sensitivity and specificity allowing the definition and scoring of different range of calprotectin subscores. We incorporated the calprotectin score in the mPDAI obtaining a new score that shows the same specificity as PDAI for diagnosis of pouchitis and higher sensitivity when compared with mPDAI. The use of the proposed new score, once validated in a larger series of patients, might be useful in the early management of patients with symptoms of pouchitis.
袋炎是溃疡性结肠炎（UC）行直肠结肠切除回肠储袋肛管吻合术后最常见的并发症。为了提供袋炎的标准化临床定义，在内镜和组织学标志物在袋病活动指数（PDAI）中进行了分组和加权。然而，由于组织学分析所需时间导致最终评分评估延迟，仍然是该指数在临床实践中应用的主要障碍，因此有人提出使用排除组织学亚评分的改良PDAI（mPDAI）。我们测试了测量储袋腔内钙卫蛋白的能力，以模拟PDAI中定义的组织学评分，我们将该指数作为袋炎诊断的金标准。通过ELISA法测量了40例连续J型储袋患者在内镜检查期间收集的储袋腔内钙卫蛋白。计算了每位患者的PDAI和mPDAI，15%的患者被mPDAI错误分类。钙卫蛋白值与急性组织学亚评分≥3的ROC分析确定了不同的钙卫蛋白临界值，以及相应的敏感性和特异性，从而可以定义和划分不同范围的钙卫蛋白亚评分。我们将钙卫蛋白评分纳入mPDAI，得到了一个新的评分，该评分在诊断袋炎时显示出与PDAI相同的特异性，与mPDAI相比具有更高的敏感性。一旦在更大系列的患者中得到验证，所提出的新评分的使用可能有助于袋炎症状患者的早期管理。
