Division of Gastroenterology, Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea.
Division of Gastroenterology, Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea.
Scand J Gastroenterol. 2020 Feb;55(2):163-168. doi: 10.1080/00365521.2020.1714716. Epub 2020 Jan 26.
Non-invasive stool tests, including the fecal immunochemical test (FIT) and fecal calprotectin (FC), are reliable biomarkers for mucosal healing (MH) in ulcerative colitis (UC). However, which fecal test is superior for predicting MH in inactive UC patients requires evaluation. We aimed to compare the accuracy of FIT and FC results for predicting MH in quiescent UC patients. This prospective, multicenter study was conducted at three tertiary hospitals. UC patients in clinical remission for at least three months underwent colonoscopy and MH was evaluated using the Mayo endoscopic sub-score (MES). The receiver operating characteristic (ROC) curve and cutoff value with the best accuracy for predicting MH were assessed. Among 127 patients, 65 (51.2%) showed MH (MES = 0). The area under the curve (AUC) for predicting MH (MES = 0) was significantly higher for FC than for FIT (AUC 0.858 (95% confidence interval (CI) 0.784-0.913) vs. 0.707 (95% CI 0.620-0.784), < .001); there was no difference when MH included MES = 1 (MES ≤ 1) (AUC 0.820 (95% CI 0.742-0.883) vs. 0.813 (95% CI 0.734-0.877), = .891). When the cutoff value was 70 μg/g for FC and 10 ng/mL for FIT, the sensitivity, specificity, positive predictive value and negative predictive value were 89.2, 71, 76.3, and 86.3, respectively, for FC and 92.3, 50, 65.9, and 86.1, respectively, for FIT. FC is more accurate than FIT for predicting MH in quiescent UC patients. The superiority of FC might be related to the distinctive performance of FC in differentiating inflammatory levels, particularly in low-grade mucosal activity.
非侵入性粪便检测，包括粪便免疫化学检测（FIT）和粪便钙卫蛋白（FC），是溃疡性结肠炎（UC）黏膜愈合（MH）的可靠生物标志物。然而，哪种粪便检测更适合预测无活动 UC 患者的 MH 仍需评估。我们旨在比较 FIT 和 FC 结果在预测无活动 UC 患者 MH 中的准确性。这项前瞻性、多中心研究在三家三级医院进行。临床缓解至少 3 个月的 UC 患者接受结肠镜检查，并使用 Mayo 内镜亚评分（MES）评估 MH。评估预测 MH 的最佳准确性的 ROC 曲线和临界值。在 127 例患者中，65 例（51.2%）表现出 MH（MES=0）。FC 预测 MH（MES=0）的曲线下面积（AUC）明显高于 FIT（AUC 0.858[95%置信区间（CI）0.784-0.913]vs.0.707[95%CI0.620-0.784]，<.001）；当 MH 包括 MES=1（MES≤1）时，差异无统计学意义（AUC 0.820[95%CI0.742-0.883]vs.0.813[95%CI0.734-0.877]，=0.891）。当 FC 的截断值为 70μg/g，FIT 的截断值为 10ng/ml 时，FC 的灵敏度、特异性、阳性预测值和阴性预测值分别为 89.2%、71%、76.3%和 86.3%，FIT 分别为 92.3%、50%、65.9%和 86.1%。FC 比 FIT 更准确地预测无活动 UC 患者的 MH。FC 的优越性可能与 FC 在区分炎症水平方面的独特表现有关，特别是在低级别黏膜活性方面。
