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术后 3 个月内粪便钙卫蛋白水平的变化可预测克罗恩病肠切除术后内镜下复发。

Variation of faecal calprotectin level within the first three months after bowel resection is predictive of endoscopic postoperative recurrence in Crohn's disease.

机构信息

Université Clermont Auvergne, Inserm, 3iHP, CHU Clermont-Ferrand, Service d'Hépato-Gastro Entérologie, Clermont-Ferrand, France; Université Clermont Auvergne, Inserm U1071, M2iSH, USC-INRA 2018, F-63000 Clermont-Ferrand, France.

Gastroenterology Department, University Hospital, Bordeaux, France.

出版信息

Dig Liver Dis. 2020 Jul;52(7):740-744. doi: 10.1016/j.dld.2020.03.020. Epub 2020 May 20.

DOI:10.1016/j.dld.2020.03.020

PMID:32444250

Abstract

BACKGROUND

Early prediction of postoperative recurrence (POR) remains a major concern in Crohn's disease (CD).

AIMS

To assess serial faecal calprotectin (Fcal) monitoring within the first three months to predict CD endoscopic POR.

METHODS

In a multicenter randomized controlled trial, CD patients received azathioprine 2.5 mg/kg/day with oral curcumin (3 g/day) or placebo. Fcal was measured at baseline, one month (M1) and M3. Endoscopic POR at M6 was defined as Rutgeerts' index ≥ i2b (central reading).

RESULTS

Among the 48 patients included, there was no significant difference of median Fcal levels at baseline (p = 0.15), M1 (p = 0.44) and M3 (p = 0.28) between patients with or without endoscopic POR at M6. Fcal kinetics during the first 3 months after surgery was significantly different between the patients with or without POR at M6 (p = 0.021). The median variation between Fcal level at baseline and M3 (ΔFcal M3-M0) was significantly higher in patients with endoscopic POR compared to those without POR (p = 0.01). ΔFcal M3-M0 >+10% demonstrated the best performances to predict endoscopic POR at M6 (AUC=0.73, sensitivity=64.7%[41.1-82.7], specificity=87.5%[68.0-96.3], negative predictive value=77.8%[57.5-91.4] and positive predictive value=78.6%[49.2-95.3]).

CONCLUSION

Fcal variation within the first three months after ileocolonic resection is a promising predictor of early endoscopic POR in CD patients.

摘要

背景

早期预测克罗恩病（CD）术后复发（POR）仍然是一个主要关注点。

目的

评估术后前三个月内粪便钙卫蛋白（Fcal）的连续监测，以预测 CD 内镜 POR。

方法

在一项多中心随机对照试验中，CD 患者接受每天 2.5mg/kg 的硫唑嘌呤和口服姜黄素（3g/天）或安慰剂。在基线、一个月（M1）和 M3 时测量 Fcal。M6 时的内镜 POR 定义为 Rutgeerts 指数≥i2b（中心阅读）。

结果

在纳入的 48 例患者中，M6 时内镜 POR 患者与无 POR 患者的基线（p=0.15）、M1（p=0.44）和 M3（p=0.28）时的中位 Fcal 水平无显著差异。术后前 3 个月 Fcal 动力学在 M6 时有 POR 与无 POR 的患者之间有显著差异（p=0.021）。与无 POR 患者相比，有 POR 患者的基线与 M3 之间的 Fcal 水平变化（ΔFcal M3-M0）显著更高（p=0.01）。ΔFcal M3-M0＞+10%对预测 M6 时的内镜 POR 具有最佳性能（AUC=0.73，灵敏度=64.7%[41.1-82.7]，特异性=87.5%[68.0-96.3]，阴性预测值=77.8%[57.5-91.4]和阳性预测值=78.6%[49.2-95.3]）。