Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada.
Division of General Surgery, Department of Surgery, McMaster University, 50 Charlton Avenue East, Hamilton, Ontario, L8N 4A6, Canada.
Int J Colorectal Dis. 2020 Sep;35(9):1619-1628. doi: 10.1007/s00384-020-03669-w. Epub 2020 Jul 3.
Total proctocolectomy (TPC) with ileal pouch anal anastomosis (IPAA) is commonly performed for patients with refractory ulcerative colitis (UC). Pouchitis occurs in 20-50% of these patients. Fecal calprotectin is a biomarker that correlates well with the pouchitis disease activity index. However, its role in the diagnosis and management of acute pouchitis has not been thoroughly defined. The aim of this study is to review previously established cut-off values and contextualize the clinical utility of fecal calprotectin.
Search of Medline, EMBASE, CENTRAL, and PubMed was performed. Articles were eligible if they measured fecal calprotectin in the setting of pouchitis in patients who underwent TPC with IPAA for UC. Risk of bias of the included studies was evaluated with the QUADAS-2.
From 117 relevant citations, seven studies with 256 patients (44.8% female, 39.88 years) met inclusion criteria. The pooled prevalence of pouchitis was 42%. The derived fecal calprotectin cut-off values ranged from 56 to 494 μg/g. The corresponding sensitivities and specificities ranged from 57 to 100% and 38 to 92%, respectively. The area under the curve was reported in three studies and ranged from 0.832 to 0.840.
Fecal calprotectin may be a reliable diagnostic tool for acute pouchitis in patients following TPC with IPAA for UC. The high sensitivity of fecal calprotectin for detection of pouchitis makes it a valuable test for ruling out pouchitis. When used in conjunction with other biomarkers, the high specificity offers value in ruling in pouchitis. However, given the complexity of this disease process, relying solely on biomarkers for diagnosis is currently unreasonable.
全直肠结肠切除（TPC）加回肠贮袋肛管吻合术（IPAA）通常用于治疗难治性溃疡性结肠炎（UC）患者。这些患者中有 20-50%发生贮袋炎。粪便钙卫蛋白是一种与贮袋炎疾病活动指数相关性良好的生物标志物。然而，其在急性贮袋炎的诊断和管理中的作用尚未得到充分定义。本研究旨在回顾先前建立的截断值，并阐述粪便钙卫蛋白的临床应用价值。
检索 Medline、EMBASE、CENTRAL 和 PubMed。如果研究测量了接受 TPC 加 IPAA 治疗 UC 的患者中贮袋炎患者的粪便钙卫蛋白，则符合纳入标准。采用 QUADAS-2 评估纳入研究的偏倚风险。
从 117 篇相关文献中，有 7 项研究共 256 例患者（女性 44.8%，39.88 岁）符合纳入标准。贮袋炎的总患病率为 42%。得出的粪便钙卫蛋白截断值范围为 56-494μg/g。相应的敏感度和特异度范围分别为 57-100%和 38-92%。有 3 项研究报告了曲线下面积，范围为 0.832-0.840。
粪便钙卫蛋白可能是 TPC 加 IPAA 治疗 UC 后患者急性贮袋炎的可靠诊断工具。粪便钙卫蛋白对贮袋炎的高敏感度使其成为排除贮袋炎的有价值的检测手段。当与其他生物标志物联合使用时，其高特异性有助于诊断贮袋炎。然而，鉴于这种疾病过程的复杂性，目前仅依赖生物标志物进行诊断是不合理的。
