Edinburgh IBD Unit, Western General Hospital, Edinburgh, United Kingdom.
Edinburgh IBD Unit, Western General Hospital, Edinburgh, United Kingdom.
Clin Gastroenterol Hepatol. 2021 Sep;19(9):1835-1844.e6. doi: 10.1016/j.cgh.2020.08.022. Epub 2020 Aug 13.
BACKGROUND & AIMS: The level of fecal calprotectin (FC) correlates with endoscopic evidence of inflammation in Crohn's disease (CD). A treat-to-target algorithm for patients with CD, that incorporates FC, outperforms a treatment strategy based on symptoms alone in the induction of mucosal healing at 12 months. We investigated whether normalization of FC within 12 months of diagnosis of CD is associated with a reduction in disease progression.
We performed a retrospective cohort study at a tertiary IBD centre in the United Kingdom. We identified all incident cases of CD diagnosed from 2005 through 2017. Patients with a FC measurement ≥250 μg/g at diagnosis who also had at least 1 follow-up FC measurement within the first 12 months of diagnosis and >12 months of follow up were included. The last FC measurement within 12 months of diagnosis was used to determine normalization (cut-off <250 μg/g). The primary endpoint was time to first disease progression (composite of progression in Montreal disease behavior B1 to B2/3, B2 to B3, or new perianal disease; CD-related surgery; or CD-related hospitalization). Cox proportional hazards regression analysis was used to determine independent factors associated with time to first disease progression.
A total of 375 patients out of 1389 incident cases were included, with a median follow up of 5.3 years (interquartile range, 3.1-7.4 years). Normalization of FC within 12 months of diagnosis was confirmed in 43.5% of patients. Patients with normalized levels of FC had a significantly lower risk of composite disease progression (hazard ratio [HR], 0.36; 95% CI, 0.24-0.53; P < .001). They also had a lower risk of reaching any of the separate progression endpoints (progression in Montreal behavior or new perianal disease HR, 0.22; 95% CI, 0.11-0.45; P < .001; hospitalization HR, 0.33; 95% CI, 0.21-0.53; P <.001; surgery HR, 0.39; 95% CI, 0.19-0.78; P = .008) CONCLUSIONS: Normalization of FC within 12 months of diagnosis is associated with a reduced risk of progression of CD.
粪便钙卫蛋白（FC）水平与克罗恩病（CD）的内镜炎症证据相关。在 CD 患者中采用包含 FC 的治疗目标算法，优于仅基于症状的治疗策略，可在 12 个月时诱导黏膜愈合。我们研究了在 CD 诊断后 12 个月内 FC 正常化是否与疾病进展减少相关。
我们在英国的一家三级 IBD 中心进行了回顾性队列研究。我们鉴定了 2005 年至 2017 年诊断的所有新发 CD 病例。在诊断时 FC 测量值≥250 μg/g 且在诊断后 12 个月内至少有 1 次 FC 随访测量值且随访时间超过 12 个月的患者被纳入研究。在诊断后 12 个月内的最后一次 FC 测量值用于确定是否正常化（截断值<250 μg/g）。主要终点是首次疾病进展的时间（包括蒙特利尔行为 B1 至 B2/3、B2 至 B3 或新发肛周疾病的进展；CD 相关手术；或 CD 相关住院治疗）。采用 Cox 比例风险回归分析确定与首次疾病进展时间相关的独立因素。
在 1389 例新发病例中，共纳入 375 例患者，中位随访时间为 5.3 年（四分位距，3.1-7.4 年）。43.5%的患者在诊断后 12 个月内 FC 水平正常化。FC 水平正常化的患者复合疾病进展风险显著降低（风险比 [HR]，0.36；95%CI，0.24-0.53；P<.001）。他们达到任何单独进展终点的风险也较低（蒙特利尔行为或新发肛周疾病进展 HR，0.22；95%CI，0.11-0.45；P<.001；住院治疗 HR，0.33；95%CI，0.21-0.53；P<.001；手术 HR，0.39；95%CI，0.19-0.78；P=0.008）。
在诊断后 12 个月内 FC 正常化与 CD 进展风险降低相关。
