粪便钙卫蛋白水平低预测内镜缓解的溃疡性结肠炎患者的组织学愈合，并延长临床缓解时间。
Low Fecal Calprotectin Predicts Histological Healing in Patients with Ulcerative Colitis with Endoscopic Remission and Leads to Prolonged Clinical Remission.
机构信息
Inflammatory Bowel Disease Center, Shimane University Hospital, Izumo, Shimane, Japan.
Department of Internal Medicine II, Shimane University Faculty of Medicine, Izumo, Shimane, Japan.
出版信息
Inflamm Bowel Dis. 2023 Mar 1;29(3):359-366. doi: 10.1093/ibd/izac095.
BACKGROUND
Consensus regarding the cutoff value of fecal calprotectin (FC) for predicting histological healing (HH) in ulcerative colitis (UC) is lacking. This study aimed to determine an optimal FC cutoff value for predicting HH in patients with UC with clinical and endoscopic remission. Furthermore, FC's predictability for prolonged clinical remission (CR) was investigated.
METHODS
Patients with UC in clinical and endoscopic remission, defined as a partial Mayo score (PMS) ≤ 2 points and a Mayo endoscopic subscore 0-1, were prospectively enrolled. Biopsy samples were evaluated by Geboes score (GS), with HH defined as a GS < 2.0. Patients were followed for 2 years or until relapse, defined as a PMS > 2 or medication escalation.
RESULTS
Seventy-six patients with UC were included. The median FC value in patients with HH (n = 40) was 56.2 µg/g, significantly lower than that in those with histological activity (118.1 µg/g; P < .01). The area under the curve (AUC) in a receiver operating characteristic (ROC) curve analysis to predict HH for FC was 0.71 (95% confidence interval [CI], 0.59-0.83), with an optimal cutoff value of 82.7 µg/g (73% sensitivity; 64% specificity; P < .01). Of 74 patients observed for 2 years, 54 (73%) had prolonged CR. In the ROC curve analysis, the AUC to predict prolonged CR for FC was 0.79 (95% CI, 0.68-0.90), equivalent to that for HH (0.73; 95% CI, 0.64-0.86; P = .40). The optimal FC cutoff value to predict prolonged CR was 84.6 µg/g (72% sensitivity; 85% specificity; P < .01).
CONCLUSIONS
Fecal calprotectin < 82 µg/g predicts HH in patients with UC with clinical and endoscopic remission. Low FC leads to prolonged CR, equivalent to HH.
背景
目前对于粪便钙卫蛋白（FC）预测溃疡性结肠炎（UC）组织学缓解（HH）的截断值尚未达成共识。本研究旨在确定 FC 的最佳截断值，以预测 UC 患者在临床和内镜缓解时的 HH，同时还研究了 FC 对延长临床缓解（CR）的预测能力。
方法
本前瞻性研究纳入了处于临床和内镜缓解的 UC 患者，定义为部分 Mayo 评分（PMS）≤2 分和 Mayo 内镜评分 0-1 分。对活检样本进行 Geboes 评分（GS）评估，HH 定义为 GS<2.0。患者随访 2 年或直至复发，定义为 PMS>2 分或药物升级。
结果
本研究共纳入 76 例 UC 患者。HH 患者（n=40）的 FC 值中位数为 56.2 µg/g，明显低于组织学活动患者（118.1 µg/g；P<.01）。FC 预测 HH 的受试者工作特征（ROC）曲线下面积（AUC）为 0.71（95%置信区间 [CI]，0.59-0.83），最佳截断值为 82.7 µg/g（73%的敏感性；64%的特异性；P<.01）。在 74 例观察 2 年的患者中，54 例（73%）实现了延长的 CR。在 ROC 曲线分析中，FC 预测延长的 CR 的 AUC 为 0.79（95% CI，0.68-0.90），与 HH 的 AUC（0.73；95% CI，0.64-0.86；P=0.40）相当。预测延长的 CR 的最佳 FC 截断值为 84.6 µg/g（72%的敏感性；85%的特异性；P<.01）。
结论
FC<82 µg/g 预测 UC 患者在临床和内镜缓解时的 HH。低 FC 导致延长的 CR，与 HH 相当。
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