Ye Xiaoqi, Wang Ying, Wang Harry H X, Feng Rui, Ye Ziyin, Han Jing, Li Li, Zeng Zhirong, Chen Minhu, Zhang Shenghong
Department of Gastroenterology and Hepatology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong Province, China.
School of Public Health, Sun Yat-Sen University, Guangzhou, Guangdong Province, PR China.
Therap Adv Gastroenterol. 2021 Feb 27;14:1756284821994741. doi: 10.1177/1756284821994741. eCollection 2021.
Elevated fecal calprotectin (FC) levels have been reported to correlate with histological activity in patients with ulcerative colitis (UC). However, the accuracy of FC for evaluating histological activity of UC remains to be determined. The aim of this study was to determine the accuracy of FC for evaluating histological activity of UC, based on updated definitions.
Related studies were retrieved from the PubMed, Web of Science, Embase, and Cochrane databases. Adult participants diagnosed with UC were included when sufficient data could be extracted to calculate the accuracy of FC for evaluating histological activity. The primary outcome was histological response, and the secondary outcome was histological remission, defined according to a recently updated position paper of European Crohn's and Colitis Organization. Statistics were pooled using bivariate mixed-effects models. The area under the curve was estimated by summary receiver-operating characteristic curves.
Nine studies were included, from which 1039 patients were included for the analysis of histological response and 591 patients for histological remission. For the evaluation of histological response, the pooled sensitivity, specificity, and the area under the curve were 0.69 [95% confidence interval (CI): 0.52-0.82], 0.77 (95% CI: 0.63-0.87), and 0.80 (95% CI: 0.76-0.83), respectively. For the evaluation of histological remission, the corresponding estimates were 0.76 (95% CI: 0.71-0.81), 0.71 (95% CI: 0.62-0.78), and 0.79 (95% CI: 0.75-0.82), respectively. FC had a higher accuracy in studies using Nancy Index. For histological response, the cut-off values of FC ranged from 50 to 172 µg/g, and the sensitivity was higher in studies with FC cut-off values >100 µg/g (0.77 0.65).
FC is a valuable biomarker for assessing histological activity in patients with UC. A cut-off value of 100-200 µg/g is more appropriate to spare patients from an unnecessary endoscopy and biopsy.
据报道，溃疡性结肠炎（UC）患者粪便钙卫蛋白（FC）水平升高与组织学活性相关。然而，FC评估UC组织学活性的准确性仍有待确定。本研究的目的是根据最新定义确定FC评估UC组织学活性的准确性。
从PubMed、科学网、Embase和Cochrane数据库中检索相关研究。当能够提取足够的数据来计算FC评估组织学活性的准确性时，纳入诊断为UC的成年参与者。主要结局是组织学反应，次要结局是组织学缓解，根据欧洲克罗恩病和结肠炎组织最近更新的立场文件进行定义。使用双变量混合效应模型汇总统计数据。通过汇总的受试者工作特征曲线估计曲线下面积。
纳入9项研究，其中1039例患者纳入组织学反应分析，591例患者纳入组织学缓解分析。对于组织学反应的评估，汇总的敏感性、特异性和曲线下面积分别为0.69[95%置信区间（CI）：0.52 - 0.82]、0.77（95%CI：0.63 - 0.87）和0.80（95%CI：0.76 - 0.83）。对于组织学缓解的评估，相应的估计值分别为0.76（95%CI：0.71 - 0.81）、0.71（95%CI：0.62 - 0.78）和0.79（95%CI：0.75 - 0.82）。在使用南希指数的研究中，FC具有更高的准确性。对于组织学反应，FC的截断值范围为50至172μg/g，在FC截断值>100μg/g的研究中敏感性更高（0.77对0.65）。
FC是评估UC患者组织学活性的有价值生物标志物。100 - 200μg/g的截断值更适合避免患者进行不必要的内镜检查和活检。
