Piotrowicz Grażyna, Klufczyńska Agnieszka, Banaszkiewicz Piotr, Dorosz Łukasz, Rydzewska Grażyna
Department of Gastroenterology, Self-Dependent Health Care Unit of Ministry of Interior, Gdansk, Poland.
Department of Gastroenterology with Inflammatory Bowel Disease Subdivision, Central Clinical Hospital of the Ministry of the Interior and Administration, Warsaw, Poland.
Prz Gastroenterol. 2021;16(1):15-22. doi: 10.5114/pg.2020.93539. Epub 2020 Mar 9.
The aim of the study was to determine the suitability of available diagnostic methods, by means of comparison, for predicting disease activity, based on cost efficiency and sensitivity criteria.
In this study, we conducted analyses of 37 patients with Crohn's disease (CD). CD was graded as "active" or "inactive" by adopting certain cut-off values for every marker. The main assumption was that methods used to grade CD severity do not give false positive results. The authors decided to measure the agreement between the methods by applying Cohen's κ coefficient.
Endoscopy shows the highest sensitivity, negative predictive value, and accuracy in detecting CD. In the case of both intestines, the sensitivity of endoscopy reached 93.9% and the accuracy 94.6%, while the sensitivity and accuracy of enterography and calprotectin were 51.5% vs. 71,9% and 56.8% vs. 72.2%, respectively. For the large intestine, the sensitivity and accuracy of endoscopy reached 100%. For the small intestine, endoscopy had 55% sensitivity and 75% accuracy, while enterography showed only 66.7% and 81.1%, respectively. The best agreement (77.1%, = 0.005) was seen between endoscopy and calprotectin for full intestines. However, the value of Cohen's κ suggests that this agreement is moderate. The optimal cut-off value for calprotectin was 43 µg/g, and the ROC curve (AUC = 0.871) was large enough to conclude that calprotectin is a statistically significant ( < 0.001) indicator of CD activity.
Statistically significant compliance was shown only between colonoscopy and faecal calprotectin.
本研究旨在基于成本效益和敏感性标准，通过比较来确定现有诊断方法对预测疾病活动的适用性。
在本研究中，我们对37例克罗恩病（CD）患者进行了分析。通过为每个标志物采用特定的临界值，将CD分为“活动期”或“非活动期”。主要假设是用于对CD严重程度分级的方法不会产生假阳性结果。作者决定应用科恩κ系数来测量这些方法之间的一致性。
内镜检查在检测CD时显示出最高的敏感性、阴性预测值和准确性。对于肠道整体而言，内镜检查的敏感性达到93.9%，准确性达到94.6%，而小肠造影和钙卫蛋白的敏感性分别为51.5%和56.8%，准确性分别为71.9%和72.2%。对于大肠，内镜检查的敏感性和准确性均达到100%。对于小肠，内镜检查的敏感性为55%，准确性为75%，而小肠造影的敏感性和准确性分别仅为66.7%和81.1%。对于整个肠道，内镜检查和钙卫蛋白之间的一致性最佳（77.1%，P = 0.005）。然而，科恩κ值表明这种一致性为中等程度。钙卫蛋白的最佳临界值为43µg/g，ROC曲线（AUC = 0.871）足够大，足以得出钙卫蛋白是CD活动的统计学显著（P < 0.001）指标的结论。
仅结肠镜检查和粪便钙卫蛋白之间显示出统计学显著的一致性。
