Abeyratne Kavindra, Harb Martin, Bensted Karen, Ghaly Simon, Connor Susan J, Andrews Jane M, Lynch Kate D
Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia.
Gastroenterology and Hepatology Department, Liverpool Hospital South West Sydney Clinical Campuses, University of NSW Sydney, Sydney, New South Wales, Australia.
Intern Med J. 2025 Mar;55(3):461-466. doi: 10.1111/imj.16648. Epub 2025 Mar 8.
Faecal calprotectin is a reliable biomarker for lower gastrointestinal inflammation. However, there are limited data on the utility of calprotectin from stoma effluent.
The aim of this study was to determine the performance of stomal calprotectin in identifying Crohn disease activity in those with a stoma.
Patients with Crohn disease and an ileostomy or colostomy were identified from three sites in Australia using a clinical management software. Disease activity was classified based on the presence of inflammation on imaging and/or endoscopy within 3 months of the sample. The primary outcome was the median stomal calprotectin in people with active versus inactive Crohn disease. Other clinical indices, such as C-reactive protein and Harvey Bradshaw Index, were evaluated as a surrogate biomarker for disease activity.
Thirty stomal calprotectin results were identified for 23 patients with paired investigations. Of 30 cases, six had active disease. The median stomal calprotectin in active versus inactive disease were 17 μg/g (interquartile range (IQR) 5-211) and 61 μg/g (IQR 19-105, P = 0.38) respectively. Accordingly, stomal calprotectin demonstrated poor sensitivity for active disease (33% at cut-off of 50 μg/g). C-reactive protein was higher for active disease (25, IQR 5-199) compared with inactive disease (5, IQR 2-17, P = 0.06), but there was no difference in the Harvey Bradshaw Index (9 (IQR 7-11) vs 5 (3-7), P = 0.10).
Stomal calprotectin did not reliably distinguish between active and inactive Crohn disease. C-reactive protein is a more reliable biomarker for disease activity in the setting of ileostomy/colostomy. Further prospective studies are needed to identify more robust biomarkers for detecting inflammation in stoma patients.
粪便钙卫蛋白是下消化道炎症的可靠生物标志物。然而，关于造口流出物中钙卫蛋白效用的数据有限。
本研究的目的是确定造口钙卫蛋白在识别有造口的克罗恩病患者疾病活动中的表现。
利用临床管理软件从澳大利亚三个地点识别出患有克罗恩病且有回肠造口术或结肠造口术的患者。根据样本采集后3个月内影像学和/或内镜检查有无炎症来分类疾病活动情况。主要结局是活动期与非活动期克罗恩病患者的造口钙卫蛋白中位数。其他临床指标，如C反应蛋白和哈维·布拉德肖指数，被评估为疾病活动的替代生物标志物。
对23例患者进行配对研究，共获得30个造口钙卫蛋白检测结果。30例中，6例患有活动性疾病。活动期与非活动期疾病的造口钙卫蛋白中位数分别为17μg/g（四分位间距（IQR）5 - 211）和61μg/g（IQR 19 - 105，P = 0.38）。因此，造口钙卫蛋白对活动性疾病的敏感性较差（截断值为50μg/g时为33%）。与非活动期疾病（5，IQR 2 - 17，P = 0.06）相比，活动期疾病的C反应蛋白更高（25，IQR 5 - 199），但哈维·布拉德肖指数无差异（9（IQR 7 - 11）对5（3 - 7），P = 0.10）。
造口钙卫蛋白不能可靠地区分活动期和非活动期克罗恩病。在回肠造口术/结肠造口术情况下，C反应蛋白是更可靠的疾病活动生物标志物。需要进一步的前瞻性研究来确定更有效的生物标志物以检测造口患者的炎症。
