Conroy Samantha, Hale Melissa F, Cross Simon S, Swallow Kirsty, Sidhu Reena H, Sargur Ravishankar, Lobo Alan J
Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield, UK.
Academic Unit of Pathology, University of Sheffield, Sheffield, UK.
J Clin Pathol. 2018 Apr;71(4):316-322. doi: 10.1136/jclinpath-2017-204506. Epub 2017 Aug 26.
Faecal calprotectin (FC) measurement distinguishes patients with inflammatory bowel disease (IBD) from those with irritable bowel syndrome but evidence of its performance in primary care is limited.
To assess the yield of IBD from FC testing in primary care.
Retrospective review of hospital records to assess the outcome following FC testing in primary care. Investigations for all patients undergoing FC testing in a single laboratory for 6 months from 1 October 2013 to 28 February 2014 were reviewed.
410 patients (162 male; median age 42; range 16-91) were included. FC>50 µg/g was considered positive (FC+). 148/410 (36.1%; median age 44 (17-91)) were FC+ (median FC 116.5 µg/g (51-1770)). 122/148 FC-positive patients (82.4%) underwent further investigation. 97 (65.5%) underwent lower gastrointestinal endoscopy (LGIE), of which 7 (7.2%) had IBD. 49/262 (18.7%) FC-negative (FC-) patients (FC ≤50 µg/g) (median age 47 (19-76)) also underwent LGIE, of whom 3 (6.1%) had IBD.IBD was diagnosed in 11/410 (2.7%; 4 ulcerative colitis, 3 Crohn's disease, 4 microscopic colitis). 8/11 were FC+ (range 67-1170) and 3 FC-. At a 50 µg/g threshold, sensitivity for detecting IBD was 72.7%, specificity 64.9%, positive predictive value (PPV) 5.41% and negative predictive value 98.9%. Increasing the threshold to 100 µg/g reduced the sensitivity of the test for detecting IBD to 54.6%.
FC testing in primary care has low sensitivity and specificity with poor PPV for diagnosing IBD. Its use needs to be directed to those with a higher pretest probability of disease. Local services and laboratories should advise general practitioners accordingly.
粪便钙卫蛋白（FC）检测可区分炎症性肠病（IBD）患者与肠易激综合征患者，但在初级保健中其性能证据有限。
评估初级保健中FC检测对IBD的检出率。
回顾医院记录以评估初级保健中FC检测后的结果。对2013年10月1日至2014年2月28日在单个实验室接受FC检测的所有患者的检查进行了回顾。
纳入410例患者（男性162例；中位年龄42岁；范围16 - 91岁）。FC>50μg/g被视为阳性（FC+）。148/410（36.1%；中位年龄44岁（17 - 91岁））为FC+（中位FC 116.5μg/g（51 - 1770））。122/148例FC阳性患者（82.4%）接受了进一步检查。97例（65.5%）接受了下消化道内镜检查（LGIE），其中7例（7.2%）患有IBD。49/262例（18.7%）FC阴性（FC-）患者（FC≤50μg/g）（中位年龄47岁（19 - 76岁））也接受了LGIE，其中3例（6.1%）患有IBD。410例中有11例（2.7%；4例溃疡性结肠炎，3例克罗恩病，4例显微镜下结肠炎）被诊断为IBD。11例中有8例FC+（范围67 - 1170），3例FC-。在阈值为50μg/g时，检测IBD的敏感性为72.7%，特异性为64.9%，阳性预测值（PPV）为5.41%，阴性预测值为98.9%。将阈值提高到100μg/g会使检测IBD的试验敏感性降至54.6%。
初级保健中的FC检测对诊断IBD的敏感性和特异性较低，PPV较差。其使用应针对疾病预测试验概率较高的患者。当地服务机构和实验室应据此向全科医生提供建议。
