粪便钙卫蛋白作为疑似克罗恩病患者小肠胶囊内镜检查的选择工具。
Fecal Calprotectin as a Selection Tool for Small Bowel Capsule Endoscopy in Suspected Crohn's Disease.
机构信息
Department of Gastroenterology, Hospital da Senhora da Oliveira-Guimarães, Portugal; Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga/Guimarães, Portugal; and ICVS/3B's, PT Government Associate Laboratory, Braga/Guimarães, Portugal.
出版信息
Inflamm Bowel Dis. 2018 Aug 16;24(9):2033-2038. doi: 10.1093/ibd/izy098.
BACKGROUND
Small bowel capsule endoscopy (SBCE) is a firstline examination in patients with suspected Crohn's disease (CD) after negative ileocolonoscopy. Fecal calprotectin (FC) is a noninvasive marker of intestinal inflammation. The aim of this study was to evaluate the predictive value of FC in inflammatory activity detected by SBCE in patients with suspected CD.
METHODS
This is a retrospective study including patients who underwent SBCE for suspected CD between March 2015 and October 2016. FC was measured within 1 week of SBCE. Inflammatory activity at SBCE was considered significant when the Lewis score (LS) was ≥135. FC correlation with LS was assessed using the Spearman correlation. The diagnostic accuracy of FC for significant inflammatory activity at SBCE was calculated by the area under the receiver operating characteristic curve (AUC).
RESULTS
Seventy-five patients were included: 52 females (69.3%), with a mean age of 37 years. SBCE detected significant inflammatory activity (LS ≥ 135) in 42 patients (56%), and FC was positively correlated to LS (rank correlation = 0.56; P < 0.001). The AUC of FC was 0.854 for significant inflammatory activity (LS ≥ 135). For values of FC ≥100 µg/g, an LS ≥135 was found in 33 of 37 patients (89.2%, P < 0.001), corresponding to a sensitivity, specificity, positive predictive value, and negative predictive value of 78.6%, 87.9%, 89.2%, and 76.3%, respectively.
CONCLUSIONS
FC has shown a good ability to predict significant inflammatory activity in SBCE in patients with suspected CD. Thus, FC proved to be a useful tool to select patients with suspected CD for SBCE.
背景
小肠胶囊内镜（SBCE）是疑似克罗恩病（CD）患者在阴性回结肠镜检查后的一线检查。粪便钙卫蛋白（FC）是一种非侵入性的肠道炎症标志物。本研究旨在评估 FC 在疑似 CD 患者的 SBCE 检测到的炎症活动中的预测价值。
方法
这是一项回顾性研究，纳入了 2015 年 3 月至 2016 年 10 月间接受 SBCE 检查的疑似 CD 患者。在 SBCE 检查前 1 周内测量 FC。当 Lewis 评分（LS）≥135 时，认为 SBCE 存在显著炎症活动。使用 Spearman 相关系数评估 FC 与 LS 的相关性。通过接收者操作特征曲线（ROC）下面积（AUC）计算 FC 对 SBCE 显著炎症活动的诊断准确性。
结果
共纳入 75 例患者，其中女性 52 例（69.3%），平均年龄 37 岁。42 例（56%）患者的 SBCE 检测到显著炎症活动（LS≥135），FC 与 LS 呈正相关（秩相关=0.56；P＜0.001）。FC 对显著炎症活动（LS≥135）的 AUC 为 0.854。当 FC 值≥100µg/g 时，37 例患者中有 33 例（89.2%，P＜0.001）LS≥135，其灵敏度、特异性、阳性预测值和阴性预测值分别为 78.6%、87.9%、89.2%和 76.3%。
结论
FC 对疑似 CD 患者的 SBCE 中显著炎症活动有良好的预测能力。因此，FC 被证明是一种有用的工具，可以选择疑似 CD 患者进行 SBCE。
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