Vernia Filippo, Di Ruscio Mirko, Stefanelli Gianpiero, Viscido Angelo, Frieri Giuseppe, Latella Giovanni
Gastroenterology Unit, Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy.
IBD Unit, IRCCS Ospedale Sacro Cuore - Don Calabria, Verona, Italy.
J Gastroenterol Hepatol. 2020 Mar;35(3):390-400. doi: 10.1111/jgh.14950. Epub 2019 Dec 18.
Although lacking validated cutoff values, fecal calprotectin (FC), besides C-reactive protein, is considered the standard test for assessing disease activity in Crohn's disease (CD). The aim of the present review is to provide a general overview of the literature addressing the role of FC in the clinical and endoscopic assessment of disease activity in CD, seeking correlations with capsule endoscopy, response to therapy, prediction of relapse, and postoperative recurrence. A systematic search of the literature up to September 2019 was performed using Medline, Embase, and the Cochrane Library. Only papers written in English concerning FC in adult patients affected by CD were included. Pediatric studies, in vitro studies, animal studies, studies on blood/serum samples, and studies analyzing FC in ulcerative colitis or in both CD and ulcerative colitis were excluded. Out of 713 citations, 65 eligible studies were identified. FC showed high accuracy in the assessment of intestinal inflammation and response to therapy, in particular in colonic disease, thus proving a good surrogate marker for these aims. FC is useful in identifying patients at high risk for endoscopic relapse or postoperative recurrence, for optimizing or downstage therapy. Unfortunately, FC performs less well in small bowel CD. FC is an effective fecal marker in the management of CD patients, optimizing the use of endoscopic procedures. Owing to its diagnostic accuracy, FC may represent a cornerstone of the "treat-to-target" management strategy of CD patients.
尽管缺乏经过验证的临界值，但除了C反应蛋白外，粪便钙卫蛋白（FC）被认为是评估克罗恩病（CD）疾病活动度的标准检测方法。本综述的目的是对有关FC在CD疾病活动度的临床和内镜评估中的作用的文献进行全面概述，探寻其与胶囊内镜检查、治疗反应、复发预测及术后复发的相关性。使用Medline、Embase和Cochrane图书馆对截至2019年9月的文献进行了系统检索。仅纳入了关于成年CD患者FC的英文文献。排除了儿科研究、体外研究、动物研究、血液/血清样本研究以及分析溃疡性结肠炎或同时分析CD和溃疡性结肠炎中FC的研究。在713篇文献中，确定了65项符合条件的研究。FC在评估肠道炎症和治疗反应方面显示出较高的准确性，尤其是在结肠疾病中，因此证明是实现这些目标的良好替代标志物。FC有助于识别内镜复发或术后复发高风险患者，以优化或降低治疗强度。遗憾的是，FC在小肠CD中的表现较差。FC是CD患者管理中的一种有效粪便标志物，可优化内镜检查程序的使用。由于其诊断准确性，FC可能代表CD患者“达标治疗”管理策略的基石。
