Division of Gastroenterology and Hepatology, Department of Internal Medicine, Toho University Sakura Medical Centre, Chiba, Japan.
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Toho University Sakura Medical Centre, Chiba, Japan.
Clin Gastroenterol Hepatol. 2017 Jan;15(1):56-62. doi: 10.1016/j.cgh.2016.08.015. Epub 2016 Aug 23.
BACKGROUND & AIMS: Previous studies have not found a correlation between fecal level of calprotectin and small bowel Crohn's disease (CD). However, these studies evaluated patients mainly by ileocolonoscopy, which views up to only the terminal ileum rather than entire small intestine. We investigated whether level of fecal calprotectin (FC) is a marker of active CD of the small bowel, identified by balloon-assisted enteroscopy and computed tomography enterography (CTE).
We performed a prospective study of 123 patients with CD (35 with ileitis, 72 with ileocolitis, and 16 with colitis) evaluated by balloon-assisted enteroscopy from May 2012 through July 2015 at Toho University Sakura Medical Centre in Japan. Patients with strictures detected by balloon-assisted enteroscopy were evaluated by CTE (n = 17). Fecal samples were collected from each patient, and levels of calprotectin were measured; patient demographic variables and medical history were also collected. We developed a CTE scoring system for disease severity that was based on bowel wall thickness, mural hyperenhancement, and engorged vasa recta. The association between level of FC and simple endoscopic index for CD score or CTE was evaluated by using Spearman rank correlation coefficient.
Level of FC correlated with the simple endoscopic index for CD score (r = 0.6362, P < .0001), even in patients with only active disease of the small intestine (r = 0.6594, P = .0005). In the 17 patients with strictures that could not be passed with the enteroscope, CTE detected all lesions beyond the strictures as well as areas in the distal side of the strictures. Level of FC correlated with CTE score in these patients (r = 0.4018, P = .0011, n = 63). In receiver operating characteristic analyses, the FC cutoff value for mucosal healing was 215 μg/g; this cutoff value identified patients with healing with 82.8% sensitivity, 71.4% specificity, positive predictive value of 74.3%, negative predictive value of 80.6%, odds ratio of 12.0, and area under the receiver operating characteristic curve value of 0.81.
A combination of measurement of level of FC and CTE appears to be effective for monitoring CD activity in patients with small intestinal CD, including patients with strictures that cannot be passed by conventional endoscopy.
既往研究并未发现粪便钙卫蛋白水平与小肠克罗恩病（CD）之间存在相关性。然而，这些研究主要通过回结肠镜检查评估患者，该检查仅观察末端回肠，而不是整个小肠。我们通过气囊辅助式小肠镜和计算机断层肠摄影术（CTE）评估，研究粪便钙卫蛋白（FC）水平是否为小肠 CD 活动的标志物。
2012 年 5 月至 2015 年 7 月，我们在日本东京都立樱川医疗中心对 123 例 CD 患者（35 例回肠炎，72 例回肠结肠炎，16 例结肠炎）进行前瞻性研究，这些患者均通过气囊辅助式小肠镜检查评估。17 例通过气囊辅助式小肠镜检查发现狭窄的患者通过 CTE 评估。收集每位患者的粪便样本，检测钙卫蛋白水平，并收集患者的人口统计学变量和病史。我们开发了一种基于肠壁厚度、壁强化和充盈的直肠血管的 CTE 严重程度评分系统。使用 Spearman 秩相关系数评估 FC 水平与 CD 简单内镜评分或 CTE 之间的相关性。
FC 水平与 CD 简单内镜评分相关（r=0.6362，P<0.0001），即使在仅有小肠活动期疾病的患者中也是如此（r=0.6594，P=0.0005）。在 17 例无法通过小肠镜进入的狭窄患者中，CTE 检测到狭窄部位以外以及狭窄部位远端的所有病变。这些患者的 FC 水平与 CTE 评分相关（r=0.4018，P=0.0011，n=63）。在受试者工作特征分析中，黏膜愈合的 FC 截断值为 215 μg/g；该截断值识别出黏膜愈合患者的灵敏度为 82.8%，特异性为 71.4%，阳性预测值为 74.3%，阴性预测值为 80.6%，优势比为 12.0，受试者工作特征曲线下面积值为 0.81。
FC 水平与 CTE 相结合的检测方法似乎可有效监测小肠 CD 患者，包括无法通过常规内镜检查进入的狭窄患者的 CD 活动。
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