Vázquez Morón Juan María, Pallarés Manrique Héctor, Machancoses Francisco H, Ramos Lora Manuel, Ruiz Frutos Carlos
Servicio de Aparato Digestivo, Hospital Juan Ramón Jiménez, España.
UGC Aparato Digestivo, Huelva University Hospital Complex - Hospital Juan Ramón Jiménez, Spain.
Rev Esp Enferm Dig. 2017 Feb;109(2):130-136. doi: 10.17235/reed.2017.4542/2016.
Fecal biomarkers, especially fecal calprotectin, are useful for predicting endoscopic activity in Crohn's disease; however, the cut-off point remains unclear. The aim of this paper was to analyze whether faecal calprotectin and M2 pyruvate kinase are good tools for generating highly accurate scores for the prediction of the state of endoscopic activity and mucosal healing.
The simple endoscopic score for Crohn's disease and the Crohn's disease activity index was calculated for 71 patients diagnosed with Crohn's. Fecal calprotectin and M2-PK were measured by the enzyme-linked immunosorbent assay test.
A fecal calprotectin cut-off concentration of ≥ 170 µg/g (sensitivity 77.6%, specificity 95.5% and likelihood ratio +17.06) predicts a high probability of endoscopic activity, and a fecal calprotectin cut-off of ≤ 71 µg/g (sensitivity 95.9%, specificity 52.3% and likelihood ratio -0.08) predicts a high probability of mucosal healing. Three clinical groups were identified according to the data obtained: endoscopic activity (calprotectin ≥ 170), mucosal healing (calprotectin ≤ 71) and uncertainty (71 > calprotectin < 170), with significant differences in endoscopic values (F = 26.407, p < 0.01). Clinical activity or remission modified the probabilities of presenting endoscopic activity (100% vs 89%) or mucosal healing (75% vs 87%) in the diagnostic scores generated. M2-PK was insufficiently accurate to determine scores.
The highly accurate scores for fecal calprotectin provide a useful tool for interpreting the probabilities of presenting endoscopic activity or mucosal healing, and are valuable in the specific clinical context.
粪便生物标志物，尤其是粪便钙卫蛋白，对预测克罗恩病的内镜活动情况很有用；然而，其临界值仍不明确。本文旨在分析粪便钙卫蛋白和M2丙酮酸激酶是否是用于生成高度准确评分以预测内镜活动状态和黏膜愈合的良好工具。
对71例诊断为克罗恩病的患者计算克罗恩病简易内镜评分和克罗恩病活动指数。采用酶联免疫吸附测定法检测粪便钙卫蛋白和M2-PK。
粪便钙卫蛋白临界浓度≥170μg/g（敏感性77.6%，特异性95.5%，似然比+17.06）预测内镜活动的可能性很高，而粪便钙卫蛋白临界值≤71μg/g（敏感性95.9%，特异性52.3%，似然比-0.08）预测黏膜愈合的可能性很高。根据所得数据确定了三个临床组：内镜活动组（钙卫蛋白≥170）、黏膜愈合组（钙卫蛋白≤71）和不确定组（71＜钙卫蛋白＜170），内镜值存在显著差异（F = 26.407，p＜0.01）。临床活动或缓解改变了诊断评分中出现内镜活动（100%对89%）或黏膜愈合（75%对87%）的概率。M2-PK用于确定评分时准确性不足。
粪便钙卫蛋白的高度准确评分提供了一个有用的工具，用于解读出现内镜活动或黏膜愈合的概率，且在特定临床背景下具有重要价值。
