Value of fecal calprotectin in the evaluation of patients with abdominal discomfort: an observational study.
Value of fecal calprotectin in the evaluation of patients with abdominal discomfort: an observational study.
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DOI：
10.1186/1471-230x-12-5
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发表时间：
2012-01-10
影响因子：
2.4
通讯作者：
Lehmann FS
中科院分区：
文献类型：
--
作者：
Manz M;Burri E;Rothen C;Tchanguizi N;Niederberger C;Rossi L;Beglinger C;Lehmann FS
对腹部不适患者的评估具有挑战性，根据症状选择内镜检查的患者并不可靠。我们评估了粪便钙卫蛋白在腹部不适患者中的诊断价值。在一项观察性研究中，575例腹部不适患者被转诊至瑞士巴塞尔大学医院胃肠病学和肝病学部门接受内镜检查，并入选研究。使用酶联免疫吸附试验测量研究前24小时内采集的粪便样本中的钙卫蛋白。胃肠道中存在具有临床意义的发现是本研究的主要终点。最终诊断对钙卫蛋白值设盲。有显著发现的患者中的中位钙卫蛋白水平（N = 212，中位97 μg/g，IQR 43-185）高于无显著发现的患者（N = 326，10 μg/g，IQR 10-23，P < 0.001）。识别显著结果的受试者工作特征曲线下面积（AUC）为0.877（95% CI，0.85-0.90）。使用50 μg/g作为临界值，灵敏度为73%，特异性为93%，具有良好的阳性和阴性似然比（分别为10.8和0.29）。粪便钙卫蛋白可作为上肠道（AUC 0.730，0.66-0.79）和结肠（AUC 0.912，0.88-0.94）的诊断参数，后者的诊断精度更高（P < 0.001）。在> 50岁的患者中，诊断精度保持不变（AUC 0.889 vs. 0.832，P = 0.165）。在腹部不适患者中，粪便钙卫蛋白是一种有用的非侵入性标志物，可用于识别胃肠道的临床显著发现，与年龄无关。
The evaluation of patients with abdominal discomfort is challenging and patient selection for endoscopy based on symptoms is not reliable. We evaluated the diagnostic value of fecal calprotectin in patients with abdominal discomfort. In an observational study, 575 consecutive patients with abdominal discomfort referred for endoscopy to the Department of Gastroenterology & Hepatology at the University Hospital Basel in Switzerland, were enrolled in the study. Calprotectin was measured in stool samples collected within 24 hours before the investigation using an enzyme-linked immunosorbent assay. The presence of a clinically significant finding in the gastrointestinal tract was the primary endpoint of the study. Final diagnoses were adjudicated blinded to calprotectin values. Median calprotectin levels were higher in patients with significant findings (N = 212, median 97 μg/g, IQR 43-185) than in patients without (N = 326, 10 μg/g, IQR 10-23, P < 0.001). The area under the receiver operating characteristics curve (AUC) to identify a significant finding was 0.877 (95% CI, 0.85-0.90). Using 50 μg/g as cut off yielded a sensitivity of 73% and a specificity of 93% with good positive and negative likelihood ratios (10.8 and 0.29, respectively). Fecal calprotectin was useful as a diagnostic parameter both for findings in the upper intestinal tract (AUC 0.730, 0.66-0.79) and for the colon (AUC 0.912, 0.88-0.94) with higher diagnostic precision for the latter (P < 0.001). In patients > 50 years, the diagnostic precision remained unchanged (AUC 0.889 vs. 0.832, P = 0.165). In patients with abdominal discomfort, fecal calprotectin is a useful non-invasive marker to identify clinically significant findings of the gastrointestinal tract, irrespective of age.