Department of Gastroenterology, State University of Rio de Janeiro.
Department Pathology.
Medicine (Baltimore). 2021 Jan 22;100(3):e24058. doi: 10.1097/MD.0000000000024058.
Mucosal healing (MH) has become a major target in the management of ulcerative colitis (UC). Because repeat endoscopy is expensive and invasive, we aimed to evaluate fecal calprotectin (FC) as an alternative marker to predict MH in UC.Eighty patients with UC in clinical remission were consecutively included in a prospective observational study. FC was measured using a quantitative enzyme-linked immunosorbent assay. The colonic mucosa was assessed for endoscopic and histological measures of inflammatory status. Endoscopic and histological remission were defined according to the Mayo endoscopic subscore (MES) and Geboes score (GS), respectively. Deep remission was defined as a combination of the MES and GS. FC performance and cutoff values for identifying MH and deep remission were determined using contingency tables and receiver operator characteristic (ROC) and area under the curve (AUC) analysis.The median FC concentration in patients who met the criteria for deep remission (MES ≤1 and GS < 3.1) was 65.5 μg/g, while that in patients with disease activity was 389.6 μg/g (P = .025). A FC cutoff value of 100 μg/g, determined by the ROC analysis, resulted in sensitivity and specificity of 91.7% and 57.1%, respectively, for histological remission, and 82.4% and 60.9%, respectively, for deep mucosal remission. Positive correlations were detected between FC concentrations with the histologic (CC: 0.435; P < .001) and the combined endoscopic and histologic (CC: 0.413; P < .001) scores.FC can be used confidently as a noninvasive biomarker to predict deep remission in patients with UC in clinical remission when concentrations are below 100 μg/g.
黏膜愈合（MH）已成为溃疡性结肠炎（UC）治疗的主要目标。由于重复内镜检查既昂贵又具有侵袭性，因此我们旨在评估粪便钙卫蛋白（FC）是否可以作为替代标志物来预测 UC 中的 MH。
连续纳入 80 例处于临床缓解期的 UC 患者进行前瞻性观察性研究。使用定量酶联免疫吸附试验（ELISA）检测 FC。通过内镜和组织学评估来评估结肠黏膜的炎症状态。根据 Mayo 内镜评分（MES）和 Geboes 评分（GS），内镜和组织学缓解分别定义为缓解。深度缓解定义为 MES 和 GS 的组合。使用列联表、受试者工作特征（ROC）和曲线下面积（AUC）分析确定 FC 性能和识别 MH 和深度缓解的截断值。
在满足深度缓解标准（MES≤1 和 GS＜3.1）的患者中，FC 浓度的中位数为 65.5μg/g，而在疾病活动患者中为 389.6μg/g（P=0.025）。通过 ROC 分析确定的 FC 截断值为 100μg/g，对组织学缓解的敏感性和特异性分别为 91.7%和 57.1%，对深度黏膜缓解的敏感性和特异性分别为 82.4%和 60.9%。FC 浓度与组织学（CC：0.435；P＜0.001）和联合内镜和组织学（CC：0.413；P＜0.001）评分之间存在正相关。
FC 可作为一种非侵入性生物标志物，在浓度低于 100μg/g 时，用于预测处于临床缓解期的 UC 患者的深度缓解。
