Melchior Chloé, Aziz Moutaz, Aubry Typhaine, Gourcerol Guillaume, Quillard Muriel, Zalar Alberto, Coëffier Moïse, Dechelotte Pierre, Leroi Anne-Marie, Ducrotté Philippe
Department of Gastroenterology, Rouen University Hospital, Rouen, France; Department of Physiology, Rouen University Hospital, Rouen, France; Research Group ADEN - INSERM UMR 1073, Institute for Research and Innovation in Biomedicine, Rouen, France.
Department of Pathology, Rouen University Hospital, Rouen, France.
United European Gastroenterol J. 2017 Mar;5(2):261-269. doi: 10.1177/2050640616650062. Epub 2016 Jun 23.
Irritable bowel syndrome is a multifactorial disease. Although faecal calprotectin has been shown to be a reliable marker of intestinal inflammation, its role in irritable bowel syndrome remains debated.
The aims of this prospective study were to select a subgroup of irritable bowel syndrome patients and to characterise those patients with high faecal calprotectin by systematic work-up.
Calprotectin levels were determined by enzyme-linked immunosorbent assay test in consecutive irritable bowel syndrome patients fulfilling Rome III criteria in whom normal colonoscopy and appropriate tests had excluded organic disease. Calprotectin levels were compared in irritable bowel syndrome patients, healthy controls and patients with active and quiescent Crohn's disease. When the calprotectin level was higher than 50 µg/g, the absence of ANCA/ASCA antibodies and a normal small bowel examination were required to confirm irritable bowel syndrome diagnosis. Additional explorations included assessment of irritable bowel syndrome severity, anxiety and depression, impact on quality of life, glucose and fructose breath tests, rectal distension test by barostat and quantitative and qualitative assessment of inflammation on colonic biopsies.
Among the 93 irritable bowel syndrome patients (73% women; 66.7% with diarrhoea) recruited, 34 (36.6%) had reproducibly elevated calprotectin. Although they tended to be older than those with normal calprotectin ( = 0.06), there were no other differences between the two groups. When elevated, calprotectin was correlated with age ( = 0.03, = 0.22).
Elevated faecal calprotectin was observed in one third of patients in this series, without any significant association with a specific clinical phenotype (except age) or specific abnormalities.
肠易激综合征是一种多因素疾病。尽管粪便钙卫蛋白已被证明是肠道炎症的可靠标志物，但其在肠易激综合征中的作用仍存在争议。
这项前瞻性研究的目的是选择一组肠易激综合征患者，并通过系统检查对粪便钙卫蛋白水平高的患者进行特征描述。
采用酶联免疫吸附试验测定连续符合罗马III标准且结肠镜检查正常及相关检查排除器质性疾病的肠易激综合征患者的钙卫蛋白水平。比较肠易激综合征患者、健康对照者以及活动期和缓解期克罗恩病患者的钙卫蛋白水平。当钙卫蛋白水平高于50μg/g时，需排除抗中性粒细胞胞浆抗体/抗酿酒酵母抗体且小肠检查正常才能确诊肠易激综合征。其他检查包括评估肠易激综合征的严重程度、焦虑和抑郁情况、对生活质量的影响、葡萄糖和果糖呼气试验、通过恒压器进行直肠扩张试验以及对结肠活检组织炎症进行定量和定性评估。
在招募的93例肠易激综合征患者中（73%为女性；66.7%有腹泻症状），34例（36.6%）的钙卫蛋白水平反复升高。尽管他们的年龄往往比钙卫蛋白水平正常的患者大（P = 0.06），但两组之间没有其他差异。钙卫蛋白水平升高时，与年龄相关（P = 0.03，r = 0.22）。
本研究系列中有三分之一的患者粪便钙卫蛋白水平升高，与特定临床表型（年龄除外）或特定异常无明显关联。
