Uchino Motoi, Horio Yuki, Kuwahara Ryuichi, Kusunoki Kurando, Nagano Kentaro, Ikeuchi Hiroki
Division of Inflammatory Bowel Disease Surgery, Department of Gastroenterological Surgery, Hyogo Medical University, Nishinomiya, Japan.
Inflamm Intest Dis. 2023 Jul 12;8(2):77-83. doi: 10.1159/000531654. eCollection 2023 Oct.
Recently, fecal calprotectin has been identified and used as an assessment tool for the confirmation of disease activity in ulcerative colitis. Although a meta-analysis suggested the usefulness of fecal calprotectin for the assessment of pouchitis, the number of participants was still insufficient. Therefore, we prospectively measured fecal calprotectin levels during pouchoscopy and analyzed their associations with pouchitis.
Patients who underwent pouchoscopy after total proctocolectomy and ileal pouch-anal anastomosis for ulcerative colitis were included. Fecal samples were collected for the measurement of calprotectin during pouchoscopy. Patients either with or without suspicious pouchitis were included. Pouchitis was defined as a modified pouchitis disease activity index (m-PDAI) score of ≥5. The associations between the development of pouchitis and the m-PDAI score and fecal calprotectin and serum markers, including C-related protein, albumin, and white blood cells, were assessed.
A total of 170 patients were included. Seventy-two patients were diagnosed with pouchitis with an m-PDAI score of 7.3 ± 1.5. The values of fecal calprotectin were 1,500 ± 1,544 μg/g in patients with pouchitis and 259 ± 402 μg/g in patients without pouchitis ( < 0.01). The correlation coefficient between calprotectin and the m-PDAI score was significant ( = 0.279, < 0.001). The cutoff value of fecal calprotectin in receiver operating characteristic analysis was 246 μg/g (area under curve 0.85, sensitivity 83.9%, specificity 71.0%). Fecal samples were able to be collected from 6 patients. The levels of fecal calprotectin significantly decreased from 2,101.3 ± 880.3 μg/g to 284.2 ± 96.9 μg/g in response to the treatment.
Elevated fecal calprotectin appeared to be significantly correlated with pouchitis. We should consider the alteration of this marker during treatments in further studies.
最近，粪便钙卫蛋白已被确定并用作评估溃疡性结肠炎疾病活动的工具。尽管一项荟萃分析表明粪便钙卫蛋白对袋炎评估有用，但参与者数量仍不足。因此，我们前瞻性地测量了袋镜检查期间的粪便钙卫蛋白水平，并分析了它们与袋炎的关联。
纳入因溃疡性结肠炎接受全直肠结肠切除术和回肠袋肛管吻合术后接受袋镜检查的患者。在袋镜检查期间收集粪便样本以测量钙卫蛋白。纳入有或无可疑袋炎的患者。袋炎定义为改良袋炎疾病活动指数（m-PDAI）评分≥5。评估袋炎的发生与m-PDAI评分、粪便钙卫蛋白和血清标志物（包括C反应蛋白、白蛋白和白细胞）之间的关联。
共纳入170例患者。72例患者被诊断为袋炎，m-PDAI评分为7.3±1.5。袋炎患者的粪便钙卫蛋白值为1500±1544μg/g，无袋炎患者为259±402μg/g（P<0.01）。钙卫蛋白与m-PDAI评分之间的相关系数显著（r=0.279，P<0.001）。在接受者操作特征分析中，粪便钙卫蛋白的截断值为246μg/g（曲线下面积0.85，敏感性83.9%，特异性71.0%）。6例患者能够采集粪便样本。治疗后，粪便钙卫蛋白水平从2101.3±880.3μg/g显著降至284.2±96.9μg/g。
粪便钙卫蛋白升高似乎与袋炎显著相关。在进一步研究中，我们应考虑该标志物在治疗期间的变化。
