Significance of fecal calprotectin and colonoscopy in diagnosis and classification of ulcerative colitis
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摘要: 目的 分析探讨粪便钙卫蛋白(fecal calprotectin，FC)及血液检查等实验室指标在溃疡性结肠炎(UC)患者诊断及病情监测中的临床应用价值。方法 收集2020年1月至2022年7月消化内科诊治的UC患者临床资料79例次(61例，有重复病例)作为实验组，选择同期在我院诊断为功能性胃肠功能紊乱的50例患者作为对照组，分析比较实验组与对照组的FC浓度水平。综合临床表现及内镜下所见将UC患者按照病情活动性分为活动组和缓解组，并根据蒙特利尔分型法对UC患者进行疾病分型。分析不同分型和活动性UC患者的FC浓度差异及FC与相关血液指标：白细胞计数(WBC)、C反应蛋白(CRP)、中性粒细胞百分比(NEU%)、血沉(ESR)、降钙素原(PCT)、白细胞介素6(IL-6)、血红蛋白(HGB)、血细胞比容(HCT)的关系，绘制ROC曲线，分析各指标对判断疾病活动性的诊断效能，比较各指标与疾病活动性的相关性。结果 UC患者FC浓度显著高于对照组，差异有统计学意义(P < 0.05)。UC活动组FC浓度显著高于缓解组，差异有统计学意义(P < 0.05)。不同病变范围的UC患者间FC浓度差异无统计学意义(P>0.05)，但随着病变范围扩大，FC浓度有升高趋势。直肠型组、左半结肠型组和全结肠型病变组分型的UC患者活动期FC浓度均高于缓解期，差异无统计学意义。直肠型组UC患者与对照组比较FC浓度差异无统计学意义，但活动期直肠型组UC患者FC浓度与对照组比较差异有统计学意义；左半结肠型组和全结肠型病变组UC患者FC浓度与对照组比较差异有统计学意义。各实验室检查指标中，FC对UC的诊断准确性最高，各血液相关指标对UC的诊断准确性排序为IL-6>CRP>WBC>ESR>NEU%>HCT>HGB>PCT。结论 FC与UC患者内镜下表现和临床严重程度有很好的相关性，其诊断效能高于各血液相关指标，FC在UC患者诊断及病情监测中发挥重要作用，可作为UC患者诊断及治疗的辅助无创性指标。Abstract: Objective To analyze and discuss the clinical application value of fecal calprotectin(FC) and blood laboratory indexes in the diagnosis and monitoring of ulcerative colitis(UC) patients.Methods The clinical data of 79 UC patients diagnosed and treated in the Department of Gastroenterology of our hospital from January 2020 to July 2022 were retrospectively analyzed as the experimental group, and 50 patients diagnosed with functional gastrointestinal dysfunction in our hospital in the same period were selected as the control group. The FC concentration levels of the experimental group and the control group were analyzed and compared. UC patients were divided into active group and remission group according to their clinical manifestations and endoscopic findings, and they were classified according to Montreal classification method. The difference of FC concentration in UC patients with different types and activities, and the relationship between FC and relevant blood indicators were analyzed, including white blood cell, C-reactive protein(CRP), neutrophil percentage(NEU%), erythrocyte sedimentation rate(ESR), procalcitonin(PCT), interleukin-6(IL-6), hemoglobin(HGB), hematocrit(HCT), ROC curves were drawn, and the diagnostic efficacy of each indicator in judging disease activity were analyzed, and the correlation between each index and disease activity was compared.Results The FC concentration in UC patients was significantly higher than that in the control group, and the difference was statistically significant(P < 0.05). FC concentration in UC active group was significantly higher than that in remission group, and the difference was statistically significant(P < 0.05). There was no significant difference in FC concentration between UC patients with different lesion ranges(P>0.05), but the FC concentration tended to increase with the expansion of lesion ranges. The FC concentration of UC patients in rectal type group, left hemicolon type group and whole colon type lesion group was higher in active phase than in remission phase, with significant difference. There was no significant difference in FC concentration between UC patients in rectal type group and control group, but there was significant difference in FC concentration between UC patients in rectal type group and control group in active phase. The concentration of FC in UC patients with left hemicolon type and whole colon type lesions was significantly different from that in the control group. Among the laboratory examination indexes, FC had the highest diagnostic accuracy for UC, and the order of diagnostic accuracy of blood related indexes for UC was IL-6>CRP>WBC>ESR>NEU%>HCT>HGB>PCT.Conclusion FC had a good correlation with the endoscopic performance and clinical severity of UC patients, and its diagnostic efficiency was higher than all blood related indicators. FC might play an important role in the diagnosis and condition monitoring of UC patients, and can be used as an auxiliary non-invasive indicator for the diagnosis and treatment of UC patients.
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Key words:
- fecal calprotectin /
- ulcerative colitis /
- enteroscopy /
- activity
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[1] Maaser C, Petersen F, Helwig U, et al. Intestinal ultrasound for monitoring therapeutic response in patients with ulcerative colitis: results from the TRUST&UC study[J]. Gut, 2020, 69(9): 1629-1636. doi: 10.1136/gutjnl-2019-319451
[2] Walsh A, Kormilitzin A, Hinds C, et al. Defining Faecal Calprotectin Thresholds as a Surrogate for Endoscopic and Histological Disease Activity in Ulcerative Colitis-a Prospective Analysis[J]. J Crohns Colitis, 2019, 13(4): 424-430. doi: 10.1093/ecco-jcc/jjy184
[3] 何琼, 李建栋. 炎症性肠病流行病学研究进展[J]. 实用医学杂志, 2019, 35(18): 2962-2966. doi: 10.3969/j.issn.1006-5725.2019.18.029
[4] 牛丽娜, 李艳梅, 刘小方. 粪便钙卫蛋白、降钙素原在溃疡性结肠炎及腹泻型肠易激综合征诊断中的临床意义[J]. 现代消化及介入诊疗, 2018, 23(6): 742-747. doi: 10.3969/j.issn.1672-2159.2018.06.016
[5] Xie T, Zhao C, Ding C, et al. Fecal calprotectin as an alternative to ulcerative colitis endoscopic index of severity to predict the response to corticosteroids of acute severe ulcerative colitis: A prospective observational study[J]. Dig Liver Dis, 2017, 49(9): 984-990. doi: 10.1016/j.dld.2017.04.021
[6] Onisor D, Boeriu A, Pascarenco O, et al. Role of fecal calprotectin as a biomarker of intestinal inflammation in ulcerative colitis: A prospective study[J]. Rev Rom Med Lab, 2018, 26(3): 335-343.
[7] 中华医学会消化病学分会炎症性肠病学组. 炎症性肠病诊断与治疗的共识意见(2018年, 北京)[J]. 中华消化杂志, 2018, 38(5): 292-311. doi: 10.3760/cma.j.issn.0254-1432.2018.05.002
[8] Kamat N, Vuyyuru SK, Kedia S, et al. Correlation of fecal calprotectin and patient-reported outcome measures in patients with ulcerative colitis[J]. Intest Res, 2022, 20(2): 269-273. doi: 10.5217/ir.2021.00064
[9] 韩娟, 华文龙. 炎症标志物对溃疡性结肠炎临床价值比较[J]. 临床血液学杂志, 2021, 34(6): 390-393. https://www.cnki.com.cn/Article/CJFDTOTAL-LCXZ202106003.htm
[10] Hart L, Chavannes M, Kherad O, et al. Faecal Calprotectin Predicts Endoscopic and Histological Activity in Clinically Quiescent Ulcerative Colitis[J]. J Crohns Colitis, 2020, 14(1): 46-52. doi: 10.1093/ecco-jcc/jjz107
[11] 陈金敏, 高山, 童旭东. 非侵入性分子标志物对溃疡性结肠炎内镜活动度的判断价值[J]. 胃肠病学, 2019, 24(5): 298-301. https://www.cnki.com.cn/Article/CJFDTOTAL-WIEC201905010.htm
[12] Kamat N, Vuyyuru SK, Kedia S, et al. Correlation of fecal calprotectin and patient-reported outcome measures in patients with ulcerative colitis[J]. Intest Res, 2022, 20(2): 269-273. doi: 10.5217/ir.2021.00064
[13] 张宪波, 刘月皎, 陈云峰. 粪便钙卫蛋白在肠易激综合征和炎症性肠病鉴别诊断中的意义分析[J]. 现代检验医学杂志, 2021, 36(1): 124-127. https://www.cnki.com.cn/Article/CJFDTOTAL-SXYN202101032.htm
[14] 金健威, 卢光荣, 宋丽, 等. 粪便钙卫蛋白在溃疡性结肠炎活动性及病变严重程度评估中的应用价值[J]. 重庆医学, 2020, 49(7): 1140-1144. doi: 10.3969/j.issn.1671-8348.2020.07.026
[15] 张怡婷, 钱香, 任真, 等. 粪便钙卫蛋白联合血液指标在诊断及评估溃疡性结肠炎活动度中的临床价值[J]. 实用医学杂志, 2021, 37(9): 1199-1202. doi: 10.3969/j.issn.1006-5725.2021.09.021
[16] 宁萌, 孙妍, 郑长清, 等. 上海市嘉定区炎症性肠病患者的粪便钙卫蛋白检测研究[J]. 中华消化病与影像杂志(电子版), 2021, 11(5): 193-195. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHYE202105003.htm
[17] 陈伦虎, 宋方敏, 李和平, 等. 粪便钙卫蛋白联合血清降钙素原、C反应蛋白在评估溃疡性结肠炎病情严重程度中的价值[J]. 吉林医学, 2020, 41(10): 2340-2341. https://www.cnki.com.cn/Article/CJFDTOTAL-JLYX202010013.htm
[18] 林美英, 黄江山, 唐熟能. 溃疡性结肠炎患者粪便中FCP及CRP水平与病情程度的相关性[J]. 医学理论与实践, 2021, 34(20): 3619-3621. https://www.cnki.com.cn/Article/CJFDTOTAL-YXLL202120058.htm
[19] Patel A, Panchal H, Dubinsky MC. Fecal calprotectin levels predict histological healing in ulcerative colitis[J]. Inflamm Bowel Dis, 2017, 23(9): 1600-1604.
[20] 韩牧洲, 朱思莹, 施海韵, 等. 粪便钙卫蛋白联合粪便免疫化学试验在溃疡性结肠炎患者黏膜愈合中的诊断价值[J]. 现代消化及介入诊疗, 2022, 27(3): 297-301. https://www.cnki.com.cn/Article/CJFDTOTAL-XDXH202203007.htm
[21] 赵尚飞, 姜娜, 宋明全. 粪钙卫蛋白、血小板、D-二聚体及降钙素原与溃疡性结肠炎的相关性分析[J]. 中国中西医结合消化杂志, 2021, 29(6): 431-435. https://www.cnki.com.cn/Article/CJFDTOTAL-ZXPW202106012.htm
[22] 安玉秋, 王惠娟. 溃疡性结肠炎中医证型分布及与肠镜象相关性研究进展[J]. 中国中西医结合消化杂志, 2021, 29(5): 373-376. https://www.cnki.com.cn/Article/CJFDTOTAL-ZXPW202105015.htm
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