Inflammatory Bowel Disease Center, Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL, USA.
J Crohns Colitis. 2022 May 10;16(4):601-605. doi: 10.1093/ecco-jcc/jjab182.
Severe Crohn's disease [CD] can result in extensive bowel resections and need for creation of an ileostomy. Faecal calprotectin [FC] is well studied in CD management, though its role in patients who have an ileostomy is unclear. Our aim is to understand if FC is a useful adjunct to radiographic or endoscopic studies in identifying recurrent CD after surgery in patients with an ileostomy.
Between January 1, 2017, and September 30, 2020, we searched the Mayo Clinic electronic medical record retrospectively for adult patients with ICD-10 code for CD, and a surgical history of an ileostomy. Patients were included in the analysis if they had at least one FC measured and a concomitant radiographic imaging and/or endoscopic procedure. An abnormal FC was defined as greater than 60 µg/g.
Of 51 patients who met our inclusion criteria, 17 had an FC level >60 µg/g. Of these 17 patients, 14 had imaging and/or an ileoscopy confirming the presence of small bowel inflammation, with a sensitivity of 87.5%. Of the remaining 34 patients with an FC level ≤60 µg/g, 32 patients had imaging and/or ileoscopy demonstrating no small bowel inflammation, with a specificity of 91.4%. FC from an ileostomy effluent had a positive predictive value of 82.3%, a negative predictive value of 94.1% and test diagnostic accuracy of 90.1%.
FC from an ileostomy effluent is a highly sensitive and specific test for the assessment and monitoring of small bowel inflammation and disease recurrence in patients with CD.
严重的克罗恩病（CD）可导致广泛的肠道切除和需要创建回肠造口术。粪便钙卫蛋白（FC）在 CD 管理中得到了很好的研究，但其在回肠造口术患者中的作用尚不清楚。我们的目的是了解 FC 是否可作为放射性或内镜检查的辅助手段，用于识别回肠造口术后 CD 患者的疾病复发。
在 2017 年 1 月 1 日至 2020 年 9 月 30 日期间，我们回顾性地在梅奥诊所电子病历中搜索了 ICD-10 编码为 CD 且有回肠造口术史的成年患者。如果患者至少有一次 FC 检测值，并伴有相应的放射性影像学和/或内镜检查，则将其纳入分析。异常 FC 定义为大于 60 µg/g。
在符合纳入标准的 51 名患者中，有 17 名患者的 FC 水平大于 60 µg/g。在这 17 名患者中，有 14 名患者的影像学和/或回肠镜检查证实存在小肠炎症，其敏感性为 87.5%。在剩余的 34 名 FC 水平≤60 µg/g 的患者中，有 32 名患者的影像学和/或回肠镜检查显示无小肠炎症，特异性为 91.4%。回肠造口术流出物的 FC 阳性预测值为 82.3%，阴性预测值为 94.1%，检测诊断准确性为 90.1%。
回肠造口术流出物的 FC 是评估和监测 CD 患者小肠炎症和疾病复发的高度敏感和特异的检测方法。
