Asonuma Kunio, Kobayashi Taku, Kikkawa Nao, Nakano Masaru, Sagami Shintaro, Morikubo Hiromu, Miyatani Yusuke, Hojo Aya, Fukuda Tomohiro, Hibi Toshifumi
Center for Advanced IBD Research and Treatment, Kitasato University Kitasato Institute Hospital, Tokyo, Japan.
Department of Gastroenterology and Hepatology, Showa University Fujigaoka Hospital, Yokohama, Japan.
Inflamm Intest Dis. 2023 May 11;8(1):13-22. doi: 10.1159/000530825. eCollection 2023 Jan-Dec.
A large proportion of small bowel lesions in Crohn's disease (CD) may exist beyond the reach of ileocolonoscopy and there is no gold standard imaging modality to screen them, suggesting the need for optimal biomarkers. We aimed to compare the usefulness of C-reactive protein (CRP), faecal calprotectin (FC), and leucine-rich alpha-2 glycoprotein (LRG) in determining small bowel lesions of CD.
This was a cross-sectional observational study. CRP, FC, and LRG were prospectively measured in patients with quiescent CD who underwent imaging examinations (capsule or balloon-assisted endoscopy, magnetic resonance enterography, or intestinal ultrasound) selected by the physician in clinical practice. Mucosal healing (MH) of the small bowel was defined as a lack of ulcers. Patients with a CD activity index >150 and active colonic lesions were excluded.
A total of 65 patients (27, MH; 38, small bowel inflammation) were analysed. The area under the curve (AUC) of CRP, FC, and LRG was 0.74 (95% confidence interval: 0.61-0.87), 0.69 (0.52-0.81), and 0.77 (0.59-0.85), respectively. The AUC of FC and LRG in a subgroup of 61 patients with CRP <3 mg/L (26, MH; 32, small bowel inflammation) was 0.68 (0.50-0.81) and 0.74 (0.54-0.84), respectively. The cut-off of 16 μg/mL of LRG showed the highest positive predictive value of 1.00 with specificity of 1.00, while negative predictive value was highest (0.71) with sensitivity of 0.89 at the cut-off of 9 μg/mL.
LRG can accurately detect and/or exclude the small bowel lesions with two cut-off values.
克罗恩病（CD）中很大一部分小肠病变可能存在于回结肠镜检查范围之外，且尚无用于筛查这些病变的金标准成像方式，这表明需要最佳的生物标志物。我们旨在比较C反应蛋白（CRP）、粪便钙卫蛋白（FC）和富含亮氨酸的α-2糖蛋白（LRG）在确定CD小肠病变中的效用。
这是一项横断面观察性研究。对临床实践中由医生选择进行成像检查（胶囊或气囊辅助内镜检查、磁共振肠造影或肠道超声）的静止期CD患者前瞻性地测量CRP、FC和LRG。小肠黏膜愈合（MH）定义为无溃疡。排除CD活动指数>150且有活动性结肠病变的患者。
共分析了65例患者（27例，MH；38例，小肠炎症）。CRP、FC和LRG的曲线下面积（AUC）分别为0.74（95%置信区间：0.61 - 0.87）、0.69（0.52 - 0.81）和0.77（0.59 - 0.85）。在CRP<3mg/L的61例患者亚组（26例，MH；32例，小肠炎症）中，FC和LRG的AUC分别为0.68（0.50 - 0.81）和0.74（0.54 - 0.84）。LRG的截断值为16μg/mL时，阳性预测值最高，为1.00，特异性为1.00；而截断值为9μg/mL时，阴性预测值最高（0.71），敏感性为0.89。
LRG可通过两个截断值准确检测和/或排除小肠病变。
