Department of Pediatrics, Soonchunhyang University College of Medicine, Bucheon, Korea.
Department of Pediatrics, School of Medicine, Kyungpook National University, Daegu, Korea.
Gut Liver. 2022 Jan 15;16(1):62-70. doi: 10.5009/gnl20300.
BACKGROUND/AIMS: : Although mucosal healing (MH) is acknowledged as the treatment target in the treat-to-target era, there are limitations on repeated endoscopic examinations, especially in pediatric patients. We aimed to investigate whether fecal calprotectin (FC) could serve as a surrogate marker for the assessment of MH in pediatric patients with Crohn's disease (CD) who have achieved sustained clinical remission (CR) while treated with anti-tumor necrosis factor (TNF) agents.
This multicenter retrospective cross-sectional study included pediatric CD patients who had sustained a CR for at least 6 months with anti-TNF agents and who simultaneously underwent ileocolonoscopy and FC tests during follow-up. MH was defined as the absence of any ulcer on ileocolonoscopy.
A total of 131 patients were included in this study. MH was observed in 87 patients (66.7%). The FC level was significantly lower in patients with MH than in those without MH (median 49.0 mg/kg vs 599.0 mg/kg; p<0.001). According to the multivariate logistic regression analysis, FC was the only factor associated with MH (odds ratio, 0.62; 95% confidence interval [CI], 0.52 to 0.73; p<0.001). According to the receiver operating characteristic curve analysis, the optimal cutoff value for FC for the association with MH was <140 mg/kg (area under the curve 0.890, 95% CI 0.829 to 0.951, sensitivity 78.2%, specificity 88.6%, p<0.001).
FC was associated with MH in pediatric patients with CD who had achieved a sustained CR for at least 6 months with anti-TNF agents. In these patients, FC can be used to stratify patients and guide decisions regarding ileocolonoscopy in the treat-to-target era.
背景/目的：虽然黏膜愈合（MH）被认为是靶向治疗时代的治疗目标，但重复内镜检查存在局限性，特别是在儿科患者中。我们旨在研究在接受抗肿瘤坏死因子（TNF）药物治疗并达到持续临床缓解（CR）的小儿克罗恩病（CD）患者中，粪便钙卫蛋白（FC）是否可作为评估 MH 的替代标志物。
这项多中心回顾性横断面研究纳入了在接受抗 TNF 药物治疗后至少 6 个月持续 CR 且在随访期间同时接受回结肠镜检查和 FC 检查的小儿 CD 患者。MH 定义为回结肠镜检查未见任何溃疡。
本研究共纳入 131 例患者。87 例（66.7%）患者存在 MH。MH 患者的 FC 水平显著低于无 MH 患者（中位数 49.0 mg/kg 比 599.0 mg/kg；p<0.001）。多变量逻辑回归分析显示，FC 是与 MH 相关的唯一因素（比值比，0.62；95%置信区间 [CI]，0.52 至 0.73；p<0.001）。根据受试者工作特征曲线分析，FC 与 MH 相关的最佳截断值为 <140 mg/kg（曲线下面积 0.890，95%CI 0.829 至 0.951，灵敏度 78.2%，特异性 88.6%，p<0.001）。
在接受抗 TNF 药物治疗并至少持续 6 个月达到 CR 的小儿 CD 患者中，FC 与 MH 相关。在这些患者中，FC 可用于分层患者并指导靶向治疗时代的回结肠镜检查决策。
