Instituto Alfa de Gastroenterologia, Hospital das Clínicas, Universidade Federal de Minas Gerais</org, Avenida Professor Alfredo Balena, 110, 30130-100 Belo Horizonte, Minas Gerais, Brazil.
Instituto Alfa de Gastroenterologia, Hospital das Clínicas, Universidade Federal de Minas Gerais</org, Avenida Professor Alfredo Balena, 110, 30130-100 Belo Horizonte, Minas Gerais, Brazil.
Gastroenterol Hepatol. 2021 Feb;44(2):87-95. doi: 10.1016/j.gastrohep.2020.04.015. Epub 2020 Jul 15.
Proper management of the inflammatory process in Crohn's disease (CD) results in lower rates of complications. The objective of this study was to investigate the performance of isolated and combined use of fecal calprotectin (FC) and serum levels of C-reactive protein (CRP) as markers of inflammatory activity in CD and the possibility of their use as a therapeutic target.
Patients with CD and indication for colonoscopy were prospectively enrolled in the study and allocated according to the presence or absence of endoscopic inflammatory activity. The correlation between FC and CRP levels and the Simplified Endoscopic Score of Crohn's Disease (SES-CD) was performed, and the accuracy of these markers was evaluated for the diagnosis of inflammatory activity, when used alone or in series.
Eighty colonoscopies were performed in patients with CD. The FC cut-off value of 155μg/g showed high sensitivity (96%) and accuracy (78%) for the diagnosis of endoscopic activity. For CRP, the value of 6.7mg/L demonstrated sensitivity of 75% and specificity of 67%. The sequential usage of these markers (FC+CRP) showed greater specificity (82%) when compared to the use of these markers alone. Depending on the probability of inflammatory activity, different scenarios were used to evaluate the performance of these markers and an algorithm is proposed.
Combined analysis of FC and CRP, when performed consecutively, allows decisions to be made with a high degree of certainty and even eliminates the need for colonoscopy in many situations.
对克罗恩病（CD）炎症过程的恰当管理可降低并发症发生率。本研究旨在探讨粪便钙卫蛋白（FC）和血清 C 反应蛋白（CRP）单独和联合应用作为 CD 炎症活性标志物的性能，以及将其作为治疗靶点的可能性。
前瞻性纳入有结肠镜检查适应证的 CD 患者，并根据内镜下是否存在炎症活动进行分组。分析 FC 和 CRP 水平与简化克罗恩病内镜评分（SES-CD）之间的相关性，并评估这些标志物单独或串联应用时诊断炎症活动的准确性。
对 80 例 CD 患者进行了结肠镜检查。FC 截断值为 155μg/g 时，对内镜活动的诊断具有较高的敏感性（96%）和准确性（78%）。CRP 的截断值为 6.7mg/L 时，其敏感性为 75%，特异性为 67%。与单独使用这些标志物相比，这些标志物的连续使用（FC+CRP）显示出更高的特异性（82%）。根据炎症活动的可能性，采用不同的方案评估这些标志物的性能，并提出了一个算法。
FC 和 CRP 的联合分析，连续进行时，可以做出高度确定的决策，甚至在许多情况下可以消除结肠镜检查的需要。
