State Monica, Negreanu Lucian, Voiosu Theodor, Voiosu Andrei, Balanescu Paul, Mateescu Radu Bogdan
Department of Gastroenterology, Colentina Clinical Hospital, Bucharest 020125, Romania.
Department of Gastroenterology, Emergency University Hospital, Bucharest 050098, Romania.
World J Gastroenterol. 2021 Apr 28;27(16):1828-1840. doi: 10.3748/wjg.v27.i16.1828.
Mucosal healing (MH) has emerged as a key therapeutic target in inflammatory bowel disease (IBD), and achievement of this goal is documented by endoscopy with biopsy. However, colonoscopy is burdensome and invasive, and substitution with an accurate noninvasive biomarker is desirable.
To summarize published data regarding the performance of noninvasive biomarkers in assessing MH in IBD patients.
We conducted a systematic review of studies that reported the performance of biomarkers in diagnosing MH in patients with IBD. The main outcome measure was to review the diagnostic accuracy of serum and fecal markers that showed promising utility in assessing MH.
We screened 1301 articles, retrieved 46 manuscripts and included 23 articles for full-text analysis. The majority of the included manuscripts referred to fecal markers (12/23), followed by circulatory markers (8/23); only 3/23 of the included manuscripts investigated combined markers (serum and/or fecal markers). Fecal calprotectin (FC) was the most investigated fecal marker for assessing MH. In ulcerative colitis, for cutoff levels ranging between 58 mcg/g and 490 mcg/g, the sensitivity was 89.7%-100% and the specificity was 62%-93.3%. For Crohn's disease, the cutoff levels of FC ranged from 71 mcg/g to 918 mcg/g (sensitivity 50%-95.9% and specificity 52.3%-100%). The best performance for a serum marker was observed for the endoscopic healing index, which showed a comparable accuracy to the measurement of FC and a higher accuracy than the measurement of serum C-reactive protein.
Several promising biomarkers of MH are emerging but cannot yet substitute for endoscopy with biopsy due to issues with reproducibility and standardization.
黏膜愈合（MH）已成为炎症性肠病（IBD）的关键治疗靶点，这一目标的达成通过内镜检查及活检来记录。然而，结肠镜检查既繁琐又具有侵入性，因此需要用准确的非侵入性生物标志物来替代。
总结已发表的关于非侵入性生物标志物在评估IBD患者MH方面表现的数据。
我们对报告生物标志物在诊断IBD患者MH方面表现的研究进行了系统综述。主要结局指标是评估在评估MH方面显示出有前景效用的血清和粪便标志物的诊断准确性。
我们筛选了1301篇文章，检索到46篇手稿，并纳入23篇文章进行全文分析。纳入的大多数手稿涉及粪便标志物（12/23），其次是循环标志物（8/23）；纳入的手稿中只有3/23研究了联合标志物（血清和/或粪便标志物）。粪便钙卫蛋白（FC）是评估MH研究最多的粪便标志物。在溃疡性结肠炎中，对于58 mcg/g至490 mcg/g的临界值范围，敏感性为89.7%-100%，特异性为62%-93.3%。对于克罗恩病，FC的临界值范围为71 mcg/g至918 mcg/g（敏感性50%-95.9%，特异性52.3%-100%）。血清标志物中内镜愈合指数表现最佳，其准确性与FC测量相当，且高于血清C反应蛋白测量。
几种有前景的MH生物标志物正在出现，但由于可重复性和标准化问题，尚不能替代内镜检查及活检。
