Department of Gastroenterology, Hepatology and Internal Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Egypt J Immunol. 2024 Oct;31(4):27-35.
Ulcerative colitis (UC), a chronic idiopathic inflammatory disease, is caused by abnormal immune response to intestinal microflora. Colorectal cancer (CRC) is one of the leading causes of cancer-related mortality. The gold standard to establish diagnosis and assess disease activity remains endoscopy and histopathology. Non-invasive biomarkers are required for timely diagnosis of CRC and to assess disease activity as endoscopic assessment is not accepted by most patients. Enhanced trefoil factor 3 (TFF3) expression is seen following gastrointestinal tract injury. In the current study, the significance of serum TFF3 as a potential diagnostic biomarker of disease activity in naїve UC patients, and its diagnostic accuracy in CRC patients were investigated. We collected serum and fecal samples from 20 cases with active UC, 20 CRC patients, and 20 normal controls. TFF3 levels were higher in patients with active UC than in controls (p < 0.001). TFF3 cut-off value of 7.9 ng/ml could predict disease activity with sensitivity and specificity of 90% and 100%, respectively. However, the combination of TFF3, C-reactive protein (CRP), and fecal calprotectin (FC) was able to predict disease activity better than each biomarker alone by raising the sensitivity and specificity to 100%. There was no correlation between TFF3, FC, and endoscopic activity in UC assessed by ulcerative colitis endoscopic index of severity (UCEIS). In the CRC patient group, the serum level of TFF3 was significantly higher when compared to controls (p=0.012). TFF3 and the degree of dysplasia were significantly correlated (r=0.496, p=0.026). At a cut-off value of 5.9 ng/ml, serum TFF3 had a diagnostic sensitivity and specificity for CRC of 82% and 90%, respectively. In conclusion, serum TFF3 may be used as a non-invasive biomarker to predict disease activity in UC both alone and in combination with CRP and FC and it could have a potential role in diagnosis of CRC.
溃疡性结肠炎（UC）是一种慢性特发性炎症性疾病，由对肠道微生物群的异常免疫反应引起。结直肠癌（CRC）是癌症相关死亡率的主要原因之一。建立诊断和评估疾病活动的金标准仍然是内窥镜检查和组织病理学。需要非侵入性生物标志物来及时诊断 CRC，并评估疾病活动，因为大多数患者不接受内窥镜检查。增强三叶因子 3（TFF3）在胃肠道损伤后表达。在目前的研究中，研究了血清 TFF3 作为初发 UC 患者疾病活动的潜在诊断生物标志物的意义，以及其在 CRC 患者中的诊断准确性。我们收集了 20 例活动期 UC 患者、20 例 CRC 患者和 20 例正常对照者的血清和粪便样本。活动期 UC 患者的 TFF3 水平高于对照组（p<0.001）。TFF3 截断值为 7.9ng/ml 时，其预测疾病活动的敏感性和特异性分别为 90%和 100%。然而，TFF3、C 反应蛋白（CRP）和粪便钙卫蛋白（FC）的联合应用能够通过提高敏感性和特异性来更好地预测疾病活动，达到 100%。在 UC 中，TFF3 与内镜评估的溃疡性结肠炎内镜严重指数（UCEIS）之间无相关性。在 CRC 患者组中，与对照组相比，血清 TFF3 水平显著升高（p=0.012）。TFF3 与异型增生程度显著相关（r=0.496，p=0.026）。在截断值为 5.9ng/ml 时，血清 TFF3 对 CRC 的诊断敏感性和特异性分别为 82%和 90%。结论：血清 TFF3 可单独或与 CRP 和 FC 联合用于预测 UC 疾病活动，在 CRC 诊断中可能具有潜在作用。
