Ho Shaun S C, Ross Michael, Keenan Jacqueline I, Day Andrew S
Department of Pediatrics, University of Otago, Christchurch, New Zealand.
Department of Surgery, University of Otago, Christchurch, New Zealand.
Front Pediatr. 2021 Mar 5;8:609279. doi: 10.3389/fped.2020.609279. eCollection 2020.
Fecal calprotectin (FC) is a useful non-invasive screening test but elevated levels are not specific to inflammatory bowel disease (IBD). The study aimed to evaluate the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of FC alone or FC in combination with other standard blood tests in the diagnosis of IBD. Children aged <17 years who had FC (normal range <50 μg/g) measured and underwent endoscopy over 33 months in Christchurch, New Zealand were identified retrospectively (consecutive sampling). Medical records were reviewed for patient final diagnoses. One hundred and two children were included; mean age was 12.3 years and 53 were male. Fifty-eight (57%) of the 102 children were diagnosed with IBD: 49 with Crohn's disease, eight with ulcerative colitis and one with IBD-unclassified. FC of 50 μg/g threshold provided a sensitivity of 96.6% [95% confident interval (CI) 88.3-99.4%] and PPV of 72.7% (95% CI 61.9-81.4%) in diagnosing IBD. Two children with IBD however were found to have FC <50 μg/g. Sensitivity in diagnosing IBD was further improved to 98.3% (95% CI 90.7-99.1%) when including FC >50 μg/g or elevated platelet count. Furthermore, PPVs in diagnosing IBD improved when FC at various thresholds was combined with either low albumin or high platelet count. Although FC alone is a useful screening test for IBD, a normal FC alone does not exclude IBD. Extending FC to include albumin or platelet count may improve sensitivity, specificity, PPV and NPV in diagnosing IBD. However, prospective studies are required to validate this conclusion.
粪便钙卫蛋白（FC）是一种有用的非侵入性筛查试验，但水平升高并非炎症性肠病（IBD）所特有。本研究旨在评估单独使用FC或FC与其他标准血液检查联合用于诊断IBD时的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）。对在新西兰克赖斯特彻奇33个月内测量了FC（正常范围<50μg/g）并接受内镜检查的<17岁儿童进行回顾性识别（连续抽样）。查阅病历以确定患者的最终诊断。纳入了102名儿童；平均年龄为12.3岁，53名为男性。102名儿童中有58名（57%）被诊断为IBD：49名患有克罗恩病，8名患有溃疡性结肠炎，1名患有未分类的IBD。FC阈值为50μg/g时，诊断IBD的敏感性为96.6%[95%置信区间（CI）88.3 - 99.4%]，PPV为72.7%（95%CI 61.9 - 81.4%）。然而，发现两名IBD儿童的FC<50μg/g。当纳入FC >50μg/g或血小板计数升高时，诊断IBD的敏感性进一步提高到98.3%（95%CI 90.7 - 99.1%）。此外，当不同阈值的FC与低白蛋白或高血小板计数联合时，诊断IBD的PPV有所改善。虽然单独使用FC是IBD的一种有用筛查试验，但仅FC正常并不能排除IBD。将FC扩展至包括白蛋白或血小板计数可能会提高诊断IBD时的敏感性、特异性、PPV和NPV。然而，需要前瞻性研究来验证这一结论。
