Western General Hospital, Gastrointestinal Unit, Edinburgh, UK.
University of Edinburgh, Gastrointestinal Unit, Centre for Genomic and Experimental Medicine, Edinburgh, UK.
J Crohns Colitis. 2019 Mar 30;13(4):442-450. doi: 10.1093/ecco-jcc/jjy187.
Magnetic resonance enterography [MRE] is the gold standard for assessing ileal inflammation in Crohn's disease [CD]. The aim of the present study was to correlate faecal calprotectin [FC] to MRE via a simple score in an exclusive ileal cohort with long-term follow-up for association with time to surgery or biologic therapy.
In total, 150 MRE studies with matched FC [±30 days] were identified from the Edinburgh FC Register [2008-12; n = 18138]. Scans were re-read blinded to clinical data, independently, by two expert gastrointestinal radiologists, to generate a simple MRE score [range 0-10] from assessment of the worst intestinal segment plus total disease extent.
In total, 119 MRE scans were evaluated from 104 patients with ileal CD [L1 or L3 with panproctocolectomy]. Receiver operating characteristic analysis showed an area under the curve of 0.77 [0.67-0.87, p < 0.0001] for FC and MRE score >1, with an optimal cut-off of 145 μg/g for severe inflammation on MRE with 69.3% [57.6-79.5] sensitivity and 71.4% [53.7-85.4] specificity. Long-term follow-up over a median [interquartile range] of 2086 days [1786-2353] revealed FC ≥ 145 μg/g was associated with reduced biologic-free survival until 3 years following MRE, whereas MRE score [severe vs absent] was associated with reduced surgery- and biologic-free survival throughout follow-up. Backwards stepwise logistic regression revealed that length of ileal disease (odds ratio [OR] 3.8, 1.1-13.2, p = 0.034) and increased bowel wall thickness at MRE [OR 4.2, 1.6-10.7, p < 0.0001] or female sex [OR 5.2, 1.5-18.7, p = 0.011] increased the risk of biologic use or surgery, respectively.
FC correlates well with MRE assessment of ileal CD with MRE parameters associated with long-term biologic- and surgery-free remission.
磁共振肠造影术[MRE]是评估克罗恩病[CD]回肠炎症的金标准。本研究的目的是通过对长期随访的单纯回肠队列中一项简单评分与粪便钙卫蛋白[FC]相关，从而确定其与手术或生物治疗时间的关系。
从爱丁堡 FC 登记处[2008-12 年；n = 18138]中确定了 150 项具有匹配 FC[±30 天]的 MRE 研究。扫描结果由两位独立的专家胃肠放射科医生进行盲法重新读取，以根据最差肠段和总疾病范围评估生成简单的 MRE 评分[范围 0-10]。
共评估了 104 例回肠 CD[L1 或 L3 伴全结肠直肠切除术]患者的 119 项 MRE 扫描。受试者工作特征分析显示，FC 和 MRE 评分>1 的曲线下面积为 0.77[0.67-0.87，p <0.0001]，MRE 上严重炎症的最佳截断值为 145μg/g，敏感性为 69.3%[57.6-79.5]，特异性为 71.4%[53.7-85.4]。中位[四分位距]2086 天[1786-2353]的长期随访结果显示，MRE 后 FC≥145μg/g 与生物制剂无缓解生存时间缩短有关，而 MRE 评分[严重与无]与整个随访期间的手术和生物制剂无缓解生存时间缩短有关。向后逐步逻辑回归显示，回肠疾病长度（比值比[OR]3.8，1.1-13.2，p =0.034）和 MRE 时肠壁厚度增加（OR 4.2，1.6-10.7，p<0.0001）或女性（OR 5.2，1.5-18.7，p =0.011）分别增加了生物制剂或手术的使用风险。
FC 与 MRE 评估回肠 CD 具有良好的相关性，MRE 参数与长期的生物制剂和手术无缓解缓解相关。
