Takada Yoshiaki, Kiyohara Hiroki, Mikami Yohei, Taguri Masataka, Sakakibara Ryoya, Aoki Yasuhiro, Nanki Kosaku, Kawaguchi Takaaki, Yoshimatsu Yusuke, Sugimoto Shinya, Sujino Tomohisa, Takabayashi Kaoru, Hosoe Naoki, Ogata Haruhiko, Kato Motohiko, Iwao Yasushi, Nakamoto Nobuhiro, Kanai Takanori
Department of Internal Medicine, Division of Gastroenterology and Hepatology, Keio University School of Medicine, Tokyo, Japan.
Department of Health Data Science, Tokyo Medical University, Tokyo, Japan.
Ann Med. 2025 Dec;57(1):2453083. doi: 10.1080/07853890.2025.2453083. Epub 2025 Jan 17.
Leucine-rich alpha-2 glycoprotein (LRG) is a novel biomarker for Crohn's disease (CD). The utility of combination use of LRG and C-reactive protein (CRP) has not been reported. This study aimed to investigate the diagnostic performance of LRG in combination with CRP to predict endoscopic activity.
A single-centre, retrospective, cross-sectional study was conducted. Patients with CD who had serum LRG concentrations measured at least once between June 2020 and May 2021 were enrolled. Clinical activity was evaluated with the Harvey-Bradshaw Index (HBI). Spearman's rank correlation coefficient () was used to analyse the correlations between the HBI, LRG concentrations and CRP concentrations. In patients undergoing ileocolonoscopy or balloon-assisted enteroscopy within 60 days before or after LRG measurement, endoscopic activity was evaluated with the simple endoscopic score for Crohn's disease (SES-CD). The diagnostic performance of LRG and CRP for endoscopic activity was evaluated using receiver operating characteristic (ROC) analysis.
Four hundred and eighty-nine measurements in 343 patients were analysed. Although a strong correlation was found between LRG and CRP concentrations ( = 0.75), the HBI did not well correlate with LRG or CRP concentrations. Endoscopic activity was analysed in 56 patients. In diagnosing endoscopically moderate to severe activity (SES-CD > 6), the area under the ROC curve of LRG was greater than that of CRP (0.74 vs. 0.63; = .037). The optimal cut-off value estimated by Youden's index was 15.5 µg/mL for LRG, and 0.13 mg/dL for CRP. LRG and CRP concentrations were considered positive when they were above these cut-off values, and the sensitivity and specificity for an SES-CD > 6 were 58.3% and 93.8%, respectively. Dual positivity of LRG and CRP showed the highest specificity.
Combination use of dual positive LRG and CRP is useful for diagnosing endoscopically moderate to severe disease.
富含亮氨酸的α-2糖蛋白（LRG）是克罗恩病（CD）的一种新型生物标志物。LRG与C反应蛋白（CRP）联合使用的效用尚未见报道。本研究旨在探讨LRG联合CRP预测内镜活动度的诊断性能。
进行了一项单中心、回顾性横断面研究。纳入2020年6月至2021年5月期间至少测量过一次血清LRG浓度的CD患者。采用哈维-布拉德肖指数（HBI）评估临床活动度。用Spearman等级相关系数（）分析HBI、LRG浓度和CRP浓度之间的相关性。在LRG测量前后60天内接受回结肠镜检查或气囊辅助小肠镜检查的患者中，采用克罗恩病简易内镜评分（SES-CD）评估内镜活动度。使用受试者操作特征（ROC）分析评估LRG和CRP对内镜活动度的诊断性能。
分析了343例患者的489次测量结果。虽然LRG与CRP浓度之间存在强相关性（=0.75），但HBI与LRG或CRP浓度的相关性不佳。对56例患者进行了内镜活动度分析。在诊断内镜下中度至重度活动（SES-CD>6）时，LRG的ROC曲线下面积大于CRP（0.74对0.63；=0.037）。根据约登指数估计的LRG最佳截断值为15.5μg/mL，CRP为0.13mg/dL。当LRG和CRP浓度高于这些截断值时被视为阳性，SES-CD>6的敏感性和特异性分别为58.3%和93.8%。LRG和CRP双阳性显示出最高的特异性。
LRG和CRP双阳性联合使用有助于诊断内镜下中度至重度疾病。
