Holtman Gea A, Lisman-van Leeuwen Yvonne, van Rheenen Patrick F, Kollen Boudewijn J, Escher Johanna C, Kindermann Angelika, de Rijke Yolanda B, Berger Marjolein Y
Department of General Practice, University of Groningen, University Medical Center Groningen, PO Box 196, 9700 AD Groningen, The Netherlands.
Department of Paediatric Gastroenterology, University of Groningen, University Medical Center Groningen, PO Box 30001, 9700 RB Groningen, The Netherlands.
Fam Pract. 2017 Aug 1;34(4):400-406. doi: 10.1093/fampra/cmw079.
Faecal calprotectin is considered to be a valid test for ruling out inflammatory bowel disease (IBD) in children with chronic gastrointestinal symptoms in specialist care. In contrast, faecal lactoferrin has higher specificity. The recent availability of both as point-of-care tests (POCTs) makes them attractive for use in primary care.
To evaluate the test characteristics of calprotectin and lactoferrin POCTs for diagnosing IBD in symptomatic children.
We defined two prospective cohorts of children with chronic gastrointestinal symptoms: (i) children presenting to primary care (primary care cohort); (ii) children referred for specialist care (referred cohort). Baseline POCT results were compared with the outcome of either endoscopic assessment or 12 months follow-up. Clinicians were blinded to the POCT results.
In the primary care cohort, none of the 114 children had IBD, and the calprotectin and lactoferrin POCTs had specificities of 0.95 (0.89-0.98) and 0.98 (0.93-0.99), respectively. In the referred cohort, 17 of the 90 children had IBD: the sensitivity of POCT calprotectin and POCT lactoferrin were both 0.94 (0.72-0.99); and the specificity was 0.93 (0.84-0.97) and 0.99 (0.92-1.00), respectively. The POCT calprotectin could reduce the referral rate by 76% and POCT lactoferrin by 81%, while missing one child with IBD (6%).
A diagnostic test strategy in primary care using a simple POCT calprotectin or lactoferrin has the potential to reduce the need for referral for further diagnostic work-up in specialist care, with a low risk of missing a child with IBD.
在专科护理中，粪便钙卫蛋白被认为是排除患有慢性胃肠道症状儿童炎症性肠病（IBD）的有效检测方法。相比之下，粪便乳铁蛋白具有更高的特异性。近期二者作为即时检验（POCT）可供使用，这使得它们在初级护理中颇具吸引力。
评估钙卫蛋白和乳铁蛋白POCT在诊断有症状儿童IBD方面的检测特征。
我们定义了两组患有慢性胃肠道症状的前瞻性队列儿童：（i）到初级护理机构就诊的儿童（初级护理队列）；（ii）被转诊至专科护理的儿童（转诊队列）。将基线POCT结果与内镜评估结果或12个月随访结果进行比较。临床医生对POCT结果不知情。
在初级护理队列中，114名儿童均未患IBD，钙卫蛋白和乳铁蛋白POCT的特异性分别为0.95（0.89 - 0.98）和0.98（0.93 - 0.99）。在转诊队列中，90名儿童中有17名患IBD：POCT钙卫蛋白和POCT乳铁蛋白的敏感性均为0.94（0.72 - 0.99）；特异性分别为0.93（0.84 - 0.97）和0.99（0.92 - 1.00）。POCT钙卫蛋白可将转诊率降低76%，POCT乳铁蛋白可将转诊率降低81%，同时漏诊一名IBD患儿（6%）。
在初级护理中使用简单的POCT钙卫蛋白或乳铁蛋白的诊断测试策略有可能减少转诊至专科护理进行进一步诊断检查的需求，漏诊IBD患儿的风险较低。
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