富含亮氨酸的α-2糖蛋白作为一种比C反应蛋白更优的生物标志物，用于检测克罗恩病中的小肠病变。
Leucine-rich alpha-2 glycoprotein as a superior biomarker to C-reactive protein for detecting small bowel lesions in Crohn's disease.
作者信息
Ohno Masashi, Nishida Atsushi, Otsuki Akinori, Yokota Yoshihiro, Imai Takayuki, Bamba Shigeki, Inatomi Osamu
机构信息
Department of Medicine, Shiga University of Medical Science, Otsu 520-2192, Shiga, Japan.
Department of Fundamental Nursing, Shiga University of Medical Science, Otsu 520-2192, Shiga, Japan.
出版信息
World J Gastrointest Endosc. 2025 Feb 16;17(2):100793. doi: 10.4253/wjge.v17.i2.100793.
BACKGROUND
Achievement of endoscopic healing (EH) is significant in the clinical practice of inflammatory bowel disease as it is correlated with improved prognosis. Existing biomarkers, including C-reactive protein (CRP), have relatively low accuracy for predicting EH, especially in small intestinal lesions in Crohn's disease (CD); thus, noninvasive and more accurate biomarkers are required. Leucine-rich alpha-2 glycoprotein (LRG), a 50-kD protein, is produced under inflammatory conditions and has been reported to be useful in assessing disease activity in inflammatory bowel disease. However, the usefulness of LRG in small intestinal lesions in CD remains inconclusive.
AIM
To determine the usefulness of LRG for EH in small bowel lesions in CD and compare it with CRP.
METHODS
This study included 133 consecutive patients with CD who underwent balloon-assisted enteroscopy between June 2021 and March 2024 at Shiga University of Medical Science Hospital (Otsu, Japan). We retrospectively analyzed endoscopic scores in each of the ileum and colon and four markers including LRG, CRP, albumin, and Harvey-Bradshaw index (HBI). Spearman's rank correlation coefficient and receiver operating characteristic analysis were performed.
RESULTS
Either active ileal or colonic lesions exhibited significant differences in LRG, CRP, albumin, and HBI compared with EH. CRP, albumin, and HBI showed a worse correlation with endoscopic activity in the ileum than that in the colon; however, LRG did not show a worse correlation (colon, = 0.5218; ileum, = 0.5602). Receiver operating characteristic analysis revealed that LRG for EH in the ileum and colon had the same cutoff values of 12.4 μg/mL. Comparing the areas under the curve of LRG and CRP for predicting EH in the ileum revealed a significantly higher areas under the curve of LRG (95% confidence interval, 0.017-0.194; = 0.024), whereas the two showed no significant difference in the colon.
CONCLUSION
LRG is a useful biomarker in assessing the endoscopic activity of CD and is more useful than CRP in the small intestine.
背景
内镜愈合（EH）的实现在炎症性肠病的临床实践中具有重要意义，因为它与预后改善相关。现有的生物标志物，包括C反应蛋白（CRP），预测EH的准确性相对较低，尤其是在克罗恩病（CD）的小肠病变中；因此，需要非侵入性且更准确的生物标志物。富含亮氨酸的α-2糖蛋白（LRG）是一种50kD的蛋白质，在炎症条件下产生，据报道可用于评估炎症性肠病的疾病活动度。然而，LRG在CD小肠病变中的作用仍不明确。
目的
确定LRG对CD小肠病变中EH的作用，并与CRP进行比较。
方法
本研究纳入了2021年6月至2024年3月期间在滋贺医科大学医院（日本大津）连续接受气囊辅助小肠镜检查的133例CD患者。我们回顾性分析了回肠和结肠各自的内镜评分以及包括LRG、CRP、白蛋白和哈维-布拉德肖指数（HBI）在内的四个标志物。进行了Spearman等级相关系数和受试者工作特征分析。
结果
与EH相比，无论是活动性回肠还是结肠病变，LRG、CRP、白蛋白和HBI均存在显著差异。CRP、白蛋白和HBI与回肠内镜活动度的相关性比与结肠的相关性更差；然而，LRG并非如此（结肠， = 0.5218；回肠， = 0.5602）。受试者工作特征分析显示，回肠和结肠中用于EH的LRG临界值均为12.4μg/mL。比较LRG和CRP预测回肠EH的曲线下面积，发现LRG的曲线下面积显著更高（95%置信区间，0.017 - 0.194； = 0.024），而两者在结肠中无显著差异。
结论
LRG是评估CD内镜活动度的有用生物标志物，在小肠中比CRP更有用。
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