Julsgaard Mette, Hvas Christian L, Gearry Richard B, Vestergaard Thea, Fallingborg Jan, Svenningsen Lise, Kjeldsen Jens, Sparrow Miles P, Wildt Signe, Kelsen Jens, Bell Sally J
*Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark; †Department of Medicine, Horsens Hospital, Horsens, Denmark; ‡Department of Gastroenterology, St Vincent's Hospital, University of Melbourne, Melbourne, Victoria, Australia; §Department of Medicine, Christchurch Hospital, University of Otago, Christchurch, New Zealand; ‖Department of Gastroenterology, Aalborg University Hospital, Aalborg, Denmark; ¶Department of Medicine, Herning Hospital, Herning, Denmark; **Department of Gastroenterology, Odense University Hospital, University of Southern Denmark, Odense, Denmark; ††Department of Gastroenterology, Alfred Hospital, Monash University, Melbourne, Victoria, Australia; and ‡‡Department of Medicine, Køge Hospital, University of Copenhagen, Køge, Denmark.
Inflamm Bowel Dis. 2017 Jul;23(7):1240-1246. doi: 10.1097/MIB.0000000000001136.
Noninvasive biomarkers of inflammation for monitoring inflammatory bowel disease (IBD) are important in pregnancy. Clinical and laboratory markers are often affected by the physiological adaption that occurs during pregnancy, although, few, if any, data exist on fecal calprotectin (FC). We investigated FC concentrations in pregnant controls and IBD women, and whether FC correlated with physician global assessment (PGA), C-reactive protein (CRP), and Harvey-Bradshaw Index (HBI)/Simple Clinical Colitis Activity Index (SCCAI) before and after pregnancy, as well as during each trimester.
The study is a prospective multicenter study of 46 pregnant women with and 21 without IBD in Denmark, Australia, and New Zealand. Demographics, clinical parameters, and HBI/SCCAI were recorded. Stool and blood samples were obtained to determine FC and CRP concentrations.
From pregnant IBD women and pregnant controls, 174 and 21 fecal samples were collected, respectively. The median FC concentration in pregnant IBD women was 131 μg/g (range 0-3600) and in controls 0 μg/g (range 0-84) (P < 0.0001). FC strongly correlated with PGA at all 5 timepoints (r ≥ 0.80; P < 0.0001) and with HBI/SCCAI before (r = 0.66; P < 0.0001) and after pregnancy (r = 0.47; P < 0.003) but not during pregnancy (P > 0.05). An FC cutoff concentration of 250 μg/g significantly correlated with active disease according to PGA in all 5 periods (P ≤ 0.0002). CRP only significantly correlated with FC (P = 0.0007) and PGA in the second trimester (P = 0.0003). No significant correlation was found between CRP and HBI/SCCAI at any timepoint (P > 0.05).
The physiological changes that occur during pregnancy do not affect FC, in contrast to CRP and HBI/SCCAI. The combined use of FC and PGA seems optimal to assess disease activity in IBD during pregnancy.
用于监测炎症性肠病（IBD）的非侵入性炎症生物标志物在孕期很重要。临床和实验室指标常受孕期发生的生理适应性影响，不过，关于粪便钙卫蛋白（FC）的数据即便有也很少。我们调查了孕期对照组和IBD女性的FC浓度，以及FC在怀孕前后及各孕期是否与医生整体评估（PGA）、C反应蛋白（CRP）和哈维-布拉德肖指数（HBI）/简单临床结肠炎活动指数（SCCAI）相关。
该研究是一项在丹麦、澳大利亚和新西兰开展的前瞻性多中心研究，纳入了46例患有IBD的孕妇和21例未患IBD的孕妇。记录人口统计学资料、临床参数和HBI/SCCAI。采集粪便和血液样本以测定FC和CRP浓度。
分别从患有IBD的孕妇和对照孕妇中收集了174份和21份粪便样本。患有IBD的孕妇中FC浓度中位数为131μg/g（范围0 - 3600），对照组为0μg/g（范围0 - 84）（P < 0.0001）。在所有5个时间点FC与PGA均显著相关（r≥0.80；P < 0.0001），且在怀孕前（r = 0.66；P < 0.0001）和怀孕后（r = 0.47；P < 0.003）与HBI/SCCAI相关，但在孕期不相关（P > 0.05）。根据PGA，FC临界浓度250μg/g在所有5个时期均与疾病活动显著相关（P≤0.0002）。CRP仅在孕中期与FC（P = 0.0007）和PGA（P = 0.0003）显著相关。在任何时间点CRP与HBI/SCCAI之间均未发现显著相关性（P > 0.05）。
与CRP和HBI/SCCAI不同，孕期发生的生理变化不会影响FC。联合使用FC和PGA似乎是评估孕期IBD疾病活动的最佳方法。
