Rokkas Theodore, Portincasa Piero, Koutroubakis Ioannis E
Department of Gastroenterology, Henry Durant Hospital Center, Athens,
Division of Internal Medicine, "Aldo Moro" University, Bari Medical School, Bari, Italy.
J Gastrointestin Liver Dis. 2018 Sep;27(3):299-306. doi: 10.15403/jgld.2014.1121.273.pti.
Fecal calprotectin (FC) has been suggested as a sensitive biomarker of inflammatory bowel disease (IBD). However, its usefulness in assessing IBD activity needs to be more precisely defined. In this meta-analysis we aimed to determine the diagnostic performance of FC in assessing IBD endoscopic activity in adults.
We searched the databases PubMed/Medline and EMBASE, and studies which examined IBD endoscopic activity in association to FC were identified. From each study pooled data and consequently pooled sensitivity, specificity, likelihood ratios (LR), diagnostic odds ratios (DORs) and areas under the curve (AUCs) were calculated, using suitable meta-analysis software. We analyzed extracted data using fixed or random effects models, as appropriate, depending on the presence of significant heterogeneity.
We included 49 sets of data from 25 eligible for meta-analysis studies, with 298 controls and 2,822 IBD patients. Fecal calprotectin in IBD (Crohn's disease, CD and ulcerative colitis, UC) showed a pooled sensitivity of 85%, specificity of 75%, DOR of 16.3 and AUC of 0.88, in diagnosing active disease. The sub-group analysis revealed that FC performed better in UC than in CD (pooled sensitivity 87.3% vs 82.4%, specificity 77.1% vs 72.1% and AUC 0.91 vs 0.84). Examining the optimum FC cut-off levels, the best sensitivity (90.6%) was achieved at 50 μg/g, whereas the best specificity (78.2%) was found at levels >100 μg/g.
This meta-analysis showed that in adults, FC is a reliable laboratory test for assessing endoscopic activity in IBD. Its performance is better in UC than CD.
粪便钙卫蛋白（FC）被认为是炎症性肠病（IBD）的一种敏感生物标志物。然而，其在评估IBD活动度方面的实用性需要更精确地界定。在这项荟萃分析中，我们旨在确定FC在评估成人IBD内镜活动度方面的诊断性能。
我们检索了PubMed/Medline和EMBASE数据库，并确定了研究IBD内镜活动度与FC相关性的研究。使用合适的荟萃分析软件，从每项研究中汇总数据，并计算汇总敏感性、特异性、似然比（LR）、诊断比值比（DOR）和曲线下面积（AUC）。我们根据是否存在显著异质性，酌情使用固定效应模型或随机效应模型分析提取的数据。
我们纳入了来自25项符合荟萃分析条件的研究中的49组数据，其中有298名对照和2822名IBD患者。在诊断活动性疾病时，IBD（克罗恩病，CD和溃疡性结肠炎，UC）中的粪便钙卫蛋白显示汇总敏感性为85%，特异性为75%，DOR为16.3，AUC为0.88。亚组分析显示，FC在UC中的表现优于CD（汇总敏感性87.3%对82.4%，特异性77.1%对72.1%，AUC 0.91对0.84）。检查最佳FC临界值水平时，在50μg/g时达到最佳敏感性（90.6%），而在>100μg/g水平时发现最佳特异性（78.2%）。
这项荟萃分析表明，在成人中，FC是评估IBD内镜活动度的一项可靠实验室检测。其在UC中的表现优于CD。
