Universidade Federal de Santa Catarina, Departamento de Clínica Médica, Divisão de Gastroenterologia, Florianópolis, SC, Brasil.
Universidade Federal de Santa Catarina , Programa de Pós-Graduação em Ciências Médicas, Florianópolis, SC, Brasil.
Arq Gastroenterol. 2022 Apr-Jun;59(2):238-243. doi: 10.1590/S0004-2803.202202000-43.
Inflammatory bowel disease (IBD) comprises the spectrum between Crohn's disease (CD) and ulcerative colitis (UC), a condition whose prevalence in countries such as Brazil has increased significantly in recent years. Changes in the intestinal epithelial barrier function and, consequently, an increase in intestinal permeability, have been suggested as important factors in the pathogenesis of different autoimmune conditions, including IBD. Therefore, there is a need for a practical tool to assess gut barrier integrity in these patients.
To study factors associated with serum zonulin levels, a marker of intestinal permeability, in patients with IBD.
This was a cross-sectional observational study that included 117 patients with IBD and 32 healthy controls. Disease activity was assessed by the Simple Clinical Colitis Activity Index (SCCAI) in UC and by the Harvey-Bradshaw Index (HBI) in CD subjects. Zonulin levels were measured by ELISA and inflammatory cytokines by Cytometric Bead Array, using commercially available kits.
The mean age of IBD patients was 44.0±15.9 years, 66.7% were female, 57 subjects were diagnosed with CD and 60 with UC. At evaluation, clinical remission was observed in 56.7% of CD patients and in 59.2% of UC subjects. No differences were observed in zonulin levels when comparing IBD patients with the control group (95.28 ng/mL vs 96.61 ng/mL, P=0.573) and when comparing patients with CD to those with UC (79.68 ng/mL vs 106.10 ng/mL, P=0.887). Among IBD group, zonulin concentrations were higher among females, correlated positively with body mass index (BMI) and age; and negatively with hemoglobin and hematocrit. In patients with UC, zonulin correlated negatively with hemoglobin, hematocrit, and albumin; and positively with BMI and SCCAI. Among CD patients, zonulin was positively correlated with age and BMI, but not with HBI. No correlations were observed between zonulin and circulating cytokines in IBD patients.
In this cohort mostly comprised of patients in clinical remission, serum zonulin levels were not higher in patients with IBD than healthy controls, and correlated with variables not linked to baseline disease, such as sex, age and BMI. However, zonulin correlated with clinical and laboratory parameters of disease severity and activity among subjects with UC, but not among patients with CD. These findings indicate a potential role for zonulin as a biomarker in IBD, particularly in UC.
炎症性肠病（IBD）包括克罗恩病（CD）和溃疡性结肠炎（UC）之间的一系列病症，近年来，巴西等国家的 IBD 患病率显著上升。肠道上皮屏障功能的改变，以及随之而来的肠道通透性增加，被认为是包括 IBD 在内的不同自身免疫性疾病发病机制中的重要因素。因此，需要一种实用的工具来评估这些患者的肠道屏障完整性。
研究与 IBD 患者血清肠通透素（zonulin）水平相关的因素，zonulin 是肠道通透性的标志物。
这是一项横断面观察性研究，纳入了 117 例 IBD 患者和 32 名健康对照者。UC 患者采用简单临床结肠炎活动指数（SCCAI）评估疾病活动度，CD 患者采用 Harvey-Bradshaw 指数（HBI）评估疾病活动度。通过酶联免疫吸附试验（ELISA）和流式细胞术微球阵列（Cytometric Bead Array）检测 zonulin 水平，使用商业试剂盒检测炎症细胞因子。
IBD 患者的平均年龄为 44.0±15.9 岁，66.7%为女性，57 例诊断为 CD，60 例诊断为 UC。评估时，CD 患者中有 56.7%处于临床缓解期，UC 患者中有 59.2%处于临床缓解期。IBD 患者与对照组之间的 zonulin 水平无差异（95.28ng/mL 比 96.61ng/mL，P=0.573），CD 患者与 UC 患者之间的 zonulin 水平也无差异（79.68ng/mL 比 106.10ng/mL，P=0.887）。在 IBD 组中，女性的 zonulin 浓度较高，与体重指数（BMI）和年龄呈正相关，与血红蛋白和血细胞比容呈负相关。在 UC 患者中，zonulin 与血红蛋白、血细胞比容和白蛋白呈负相关，与 BMI 和 SCCAI 呈正相关。在 CD 患者中，zonulin 与年龄和 BMI 呈正相关，但与 HBI 无关。IBD 患者的 zonulin 与循环细胞因子之间无相关性。
在本队列中，大多数患者处于临床缓解期，IBD 患者的血清 zonulin 水平并不高于健康对照组，且与基线疾病无关的变量相关，如性别、年龄和 BMI。然而，zonulin 与 UC 患者的疾病严重程度和活动度的临床和实验室参数相关，但与 CD 患者无关。这些发现表明 zonulin 作为 IBD 的生物标志物具有潜在作用，特别是在 UC 中。
