Szymanska Edyta, Wierzbicka Aldona, Dadalski Maciej, Kierkus Jaroslaw
Department of Gastroenterology, Hepatology, Feeding Disorders and Pediatrics, The Children's Memorial Health Institute, 04-761 Warsaw, Poland.
Department of Biochemistry and Experimental Medicine, The Children's Memorial Health Institute, 04-761 Warsaw, Poland.
J Clin Med. 2021 Aug 30;10(17):3905. doi: 10.3390/jcm10173905.
Recent data indicate that increased intestinal permeability plays a key role in the pathogenesis of inflammatory bowel diseases (IBD) and correlates with disease flare. Since zonulin related proteins (ZRP) are the proteins that increase permeability in the epithelial layer of the small intestine by reversibly modulating the intercellular tight junctions, they may serve as a new, noninvasive biomarker of disease activity. The aim of this study was to investigate fecal ZRP in pediatric IBD patients as well as its correlation with disease activity and fecal calprotectin (FCP).
Ninety-four individuals: 47 Crohn's disease (CD) patients, 41 ulcerative colitis (UC) patients, and 6 healthy controls were examined for fecal ZRP. Values were correlated to IBD type, disease activity for IBD patients, and FCP for all children included in the study. A stool specimen was collected the day before the visit to the hospital, then fecal ZRP and FCP were tested using the ELISA test. Non-parametric statistical tests were used for data analysis.
The level of fecal ZRP was higher among IBD patients compared to the control group (CG): medians for CD-113.3 (53.6-593.6) ng/mL; UC-103.6 (50.7-418.3) ng/mL; and CG-46.9 (31.8-123.0) ng/mL ( < 0.05). No difference in fecal ZRP concentration was observed between children with CD and those with UC ( = 0.55). A slight correlation between disease activity (PCDAI for CD and PUCAI for UC) and the fecal ZRP level was found for CD ( = 0.03/R = 0.33), but not UC ( = 0.62/R = 0.08), patients. A correlation between fecal ZRP and FCP was observed (R = 0.73, = 0.00).
Fecal ZRP levels are increased among those with IBD, are associated with CD activity, and strongly correlate with FCP. Further research into the role of intestinal permeability in IBD and the clinical usefulness of ZRP in IBD is warranted.
近期数据表明，肠道通透性增加在炎症性肠病（IBD）的发病机制中起关键作用，且与疾病发作相关。由于zonulin相关蛋白（ZRP）是通过可逆地调节细胞间紧密连接来增加小肠上皮层通透性的蛋白质，它们可能作为一种新的、非侵入性的疾病活动生物标志物。本研究的目的是调查儿科IBD患者的粪便ZRP及其与疾病活动和粪便钙卫蛋白（FCP）的相关性。
对94名个体进行了粪便ZRP检测，其中包括47例克罗恩病（CD）患者、41例溃疡性结肠炎（UC）患者和6名健康对照。将检测值与IBD类型、IBD患者的疾病活动以及纳入研究的所有儿童的FCP进行相关性分析。在患者入院前一天收集粪便样本，然后使用酶联免疫吸附测定（ELISA）试验检测粪便ZRP和FCP。采用非参数统计检验进行数据分析。
与对照组（CG）相比，IBD患者的粪便ZRP水平更高：CD患者中位数为113.3（53.6 - 593.6）ng/mL；UC患者中位数为103.6（50.7 - 418.3）ng/mL；CG组中位数为46.9（31.8 - 123.0）ng/mL（P < 0.05）。未观察到CD患儿与UC患儿之间粪便ZRP浓度存在差异（P = 0.55）。发现CD患者的疾病活动（CD患者的儿科克罗恩病活动指数[PCDAI]和UC患者的儿科溃疡性结肠炎活动指数[PUCAI]）与粪便ZRP水平之间存在轻微相关性（P = 0.03 / R = 0.33），但UC患者未发现此相关性（P = 0.62 / R = 0.08）。观察到粪便ZRP与FCP之间存在相关性（R = 0.73，P = 0.00）。
IBD患者的粪便ZRP水平升高，与CD活动相关，且与FCP密切相关。有必要进一步研究肠道通透性在IBD中的作用以及ZRP在IBD中的临床应用价值。
