粪便钙卫蛋白在鉴别儿童孤立性血便中大肠息肉与其他主要病因的潜在应用。
Potential Utility of Fecal Calprotectin in Discriminating Colorectal Polyps From Other Major Etiologies in Children Presenting With Isolated Hematochezia.
机构信息
Department of Pediatrics, Ajou University Medical Center, Suwon, Korea.
Department of Pediatrics, Eulji University Hospital, Daejeon, Korea.
出版信息
J Korean Med Sci. 2022 Mar 7;37(9):e72. doi: 10.3346/jkms.2022.37.e72.
BACKGROUND
Colorectal polyps are the most common cause of isolated hematochezia in children, which requires a colonoscopy for diagnosis. We aimed to investigate the potential utility of fecal calprotectin (FC) in assessing colorectal polyps detected by colonoscopy among children presenting with isolated hematochezia.
METHODS
Pediatric patients of the age of < 18 years who had undergone both colonoscopy and FC tests for isolated hematochezia from June 2016 to May 2020 were included in the present multicenter, retrospective, cross-sectional study. Comparative analysis was conducted between major causes of isolated hematochezia and FC cut-offs for discriminating colorectal polyps were explored.
RESULTS
A total 127 patients were included. Thirty-five patients (27.6%) had colorectal polyps, followed by anal fissure (14.2%), ulcerative colitis (UC; 12.6%), and others. A significant difference in FC levels was observed between patients with colorectal polyps (median, 278.7 mg/kg), anal fissures (median, 42.2 mg/kg), and UC (median, 981 mg/kg) ( < 0.001). According to receiver operating characteristic curve analysis, among patients diagnosed with colorectal polyp or anal fissure, the most accurate FC cut-off for discriminating colorectal polyps from anal fissures on colonoscopy was 225 mg/kg (sensitivity, 59.4%; specificity, 94.4%; positive predictive value [PPV], 95.0%; negative predictive value [NPV], 56.7%; area under the curve [AUC], 0.8; 95% confidence interval [CI], 0.678-0.923; < 0.001), while among patients diagnosed with colorectal polyp or UC, the most accurate FC cut-off for discriminating colorectal polyps from UC on colonoscopy was 879 mg/kg (sensitivity, 81.2%; specificity, 56.2%; PPV, 78.8%; NPV, 60.0%; AUC, 0.687; 95% CI, 0.521-0.852; < 0.001).
CONCLUSION
FC may assist in assessing the cause of lower gastrointestinal tract bleeding in children who present with isolated hematochezia.
背景
结直肠息肉是儿童孤立性血便最常见的原因，需要进行结肠镜检查进行诊断。我们旨在研究粪便钙卫蛋白（FC）在评估因孤立性血便而行结肠镜检查的儿童中检测到的结直肠息肉的潜在效用。
方法
本研究纳入了 2016 年 6 月至 2020 年 5 月期间因孤立性血便接受结肠镜检查和 FC 检查的年龄<18 岁的儿科患者。对孤立性血便的主要病因进行了对比分析，并探讨了 FC 截断值在鉴别结直肠息肉方面的作用。
结果
共纳入 127 例患者。35 例（27.6%）患者存在结直肠息肉，其次为肛裂（14.2%）、溃疡性结肠炎（UC；12.6%）和其他疾病。结直肠息肉（中位数 278.7mg/kg）、肛裂（中位数 42.2mg/kg）和 UC（中位数 981mg/kg）患者的 FC 水平差异有统计学意义（<0.001）。根据受试者工作特征曲线分析，在诊断为结直肠息肉或肛裂的患者中，用于鉴别结肠镜下结直肠息肉和肛裂的最准确 FC 截断值为 225mg/kg（敏感性 59.4%，特异性 94.4%，阳性预测值[PPV] 95.0%，阴性预测值[NPV] 56.7%，曲线下面积[AUC] 0.8，95%置信区间[CI] 0.678-0.923；<0.001），而在诊断为结直肠息肉或 UC 的患者中，用于鉴别结肠镜下结直肠息肉和 UC 的最准确 FC 截断值为 879mg/kg（敏感性 81.2%，特异性 56.2%，PPV 78.8%，NPV 60.0%，AUC 0.687，95%CI 0.521-0.852；<0.001）。
结论
FC 可能有助于评估因孤立性血便就诊的儿童下消化道出血的病因。
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