Mater Hospital Brisbane, Brisbane, QLD.
University of Queensland, Brisbane, QLD.
Med J Aust. 2019 Nov;211(10):461-467. doi: 10.5694/mja2.50384. Epub 2019 Nov 3.
To assess the clinical effectiveness of faecal calprotectin (FC) testing for distinguishing between organic gastrointestinal diseases (organic GID), such as inflammatory bowel disease (IBD), and functional gastrointestinal disorders (functional GIDs).
Studies that assessed the accuracy of FC testing for differentiating between IBD or organic GID and functional GIDs were reviewed. Articles published in English during January 1998 - June 2018 that compared diagnostic FC testing in primary care and outpatient hospital settings with a reference test and employed the standard enzyme-linked immunosorbent FC assay method with a cut-off of 50 or 100 μg/g faeces were included. Study quality was assessed with QUADAS-2, an evidence-based quality assessment tool for diagnostic accuracy studies.
MEDLINE and EMBASE; reference lists of screened articles.
Eighteen relevant studies were identified. For distinguishing patients with organic GID (including IBD) from those with functional GIDs (16 studies), the estimated sensitivity of FC testing was 81% (95% CI, 74-86%), the specificity 81% (95% CI, 71-88%); area under the curve (AUC) was 0.87. For distinguishing IBD from functional GIDs (ten studies), sensitivity was 88% (95% CI, 80-93%), specificity 72% (95% CI, 59-82%), and AUC 0.89. Assuming a population prevalence of organic GID of 1%, the positive predictive value was 4.2%, the negative predictive value 100%. The difference in sensitivity and specificity between FC testing cut-offs of 50 μg/g and 100 μg/g faeces was not statistically significant (P = 0.77).
FC testing is clinically useful for distinguishing organic GID (including IBD) from functional GIDs, and its incorporation into clinical practice for evaluating patients with lower gastrointestinal symptoms could lead to fewer patients with functional GIDs undergoing colonoscopy, reducing costs for both patients and the health system.
CRD4201810507.
评估粪便钙卫蛋白（FC）检测在鉴别器质性胃肠疾病（有机 GID）与功能性胃肠疾病（功能性 GID）中的临床有效性。
综述了评估 FC 检测在鉴别炎症性肠病（IBD）或器质性 GID 与功能性 GID 中的准确性的研究。纳入了 1998 年 1 月至 2018 年 6 月期间发表的评估初级保健和门诊医院环境中 FC 检测诊断准确性的研究，这些研究采用了标准酶联免疫吸附 FC 检测方法，截断值为 50 或 100μg/g 粪便，并与参考检测进行了比较。采用基于证据的诊断准确性研究质量评估工具 QUADAS-2 对研究质量进行了评估。
MEDLINE 和 EMBASE；筛选文章的参考文献列表。
共确定了 18 项相关研究。用于鉴别器质性 GID（包括 IBD）患者与功能性 GID 患者（16 项研究）时，FC 检测的估计敏感性为 81%（95%CI，74-86%），特异性为 81%（95%CI，71-88%）；曲线下面积（AUC）为 0.87。用于鉴别 IBD 与功能性 GID（10 项研究）时，敏感性为 88%（95%CI，80-93%），特异性为 72%（95%CI，59-82%），AUC 为 0.89。假设器质性 GID 的人群患病率为 1%，阳性预测值为 4.2%，阴性预测值为 100%。FC 检测截断值为 50μg/g 和 100μg/g 粪便时，敏感性和特异性的差异无统计学意义（P=0.77）。
FC 检测在鉴别器质性 GID（包括 IBD）与功能性 GID 方面具有临床应用价值，将其纳入临床实践以评估下消化道症状患者，可能会减少接受结肠镜检查的功能性 GID 患者数量，从而降低患者和医疗系统的成本。
PROSPERO 注册号：CRD4201810507。
