Shimoyama Takahiro, Yamamoto Takayuki, Umegae Satoru, Matsumoto Koichi
Inflammatory Bowel Disease Centre, Yokkaichi Hazu Medical Centre, Yokkaichi, Mie, Japan.
Inflammatory Bowel Disease Centre, Yokkaichi Hazu Medical Centre, 10-8 Hazuyamacho, Yokkaichi, Mie 510-0016, Japan.
Therap Adv Gastroenterol. 2017 Aug;10(8):577-587. doi: 10.1177/1756283X17717683. Epub 2017 Jul 4.
The value of faecal biomarkers for screening small bowel inflammation in patients with Crohn's disease (CD) remains to be elucidated. This prospective study was to evaluate the utility of faecal biomarkers for detecting small intestinal inflammation.
A total of 122 consecutive patients with a diagnosis of CD in the small intestine were screened for eligibility. Computed tomography enterography (CTE) was undertaken to evaluate small bowel inflammation followed by colonoscopy to confirm no large bowel involvement. Seventy eligible patients with inflammation confined to the small intestine were included. Faecal samples were collected for assaying calprotectin, lactoferrin and haemoglobin. For assessing the degree of small bowel inflammation, a semi-quantitative scoring system (CTE0, normal; CTE1, mild; CTE2, moderate; CTE3, severe) was applied.
The median calprotectin, lactoferrin and haemoglobin levels were significantly higher in patients with small bowel inflammation, CTE scores 1-3 ( = 42) 0 ( = 28): calprotectin, 330 40 ng/ml, < 0.0001; lactoferrin, 14 3 ng/ml, < 0.0001; haemoglobin, 29.5 6.5 ng/ml, = 0.005. There was a strong positive relationship between the faecal biomarkers and CTE score: calprotectin, < 0.0001; lactoferrin, < 0.0001; haemoglobin, = 0.0004. A cutoff value of 140 ng/ml for calprotectin had a sensitivity of 69% and a specificity of 82% with an area under the receiver operating characteristic curve (AUC) of 0.82 to detect small bowel inflammation (CTE scores 1-3), while lactoferrin 6 ng/ml had a sensitivity of 69% and a specificity of 79% with an AUC of 0.83, and haemoglobin 9 ng/ml showed a sensitivity of 71% and a specificity of 39% with an AUC of 0.70.
Faecal calprotectin, lactoferrin, and to a lesser degree haemoglobin are relevant biomarkers for screening small bowel inflammation in CD patients without large bowel involvement. Further well-designed large-scale studies in this clinical setting should strengthen our findings.
粪便生物标志物在克罗恩病（CD）患者小肠炎症筛查中的价值尚待阐明。本前瞻性研究旨在评估粪便生物标志物在检测小肠炎症中的效用。
连续筛查122例诊断为小肠CD的患者是否符合条件。进行计算机断层扫描小肠造影（CTE）以评估小肠炎症，随后进行结肠镜检查以确认无大肠受累。纳入70例炎症局限于小肠的符合条件患者。收集粪便样本以检测钙卫蛋白、乳铁蛋白和血红蛋白。为评估小肠炎症程度，应用了一种半定量评分系统（CTE0，正常；CTE1，轻度；CTE2，中度；CTE3，重度）。
小肠炎症患者（CTE评分1 - 3，n = 42）的钙卫蛋白、乳铁蛋白和血红蛋白水平中位数显著高于无炎症患者（CTE评分0，n = 28）：钙卫蛋白，330 ± 40 ng/ml，P < 0.0001；乳铁蛋白，14 ± 3 ng/ml，P < 0.0001；血红蛋白，29.5 ± 6.5 ng/ml，P = 0.005。粪便生物标志物与CTE评分之间存在强正相关：钙卫蛋白，P < 0.0001；乳铁蛋白，P < 0.0001；血红蛋白，P = 0.0004。钙卫蛋白的截断值为140 ng/ml时，检测小肠炎症（CTE评分1 - 3）的灵敏度为69%，特异度为82%，受试者工作特征曲线下面积（AUC）为0.82，而乳铁蛋白截断值为6 ng/ml时，灵敏度为69%，特异度为79%，AUC为0.83，血红蛋白截断值为9 ng/ml时，灵敏度为71%，特异度为39%，AUC为0.70。
粪便钙卫蛋白、乳铁蛋白以及程度稍低的血红蛋白是筛查无大肠受累的CD患者小肠炎症的相关生物标志物。在这种临床环境中进一步设计良好的大规模研究应能强化我们的发现。
