Efficacy of noninvasive evaluations in monitoring inflammatory bowel disease activity: A prospective study in China.
Efficacy of noninvasive evaluations in monitoring inflammatory bowel disease activity: A prospective study in China.
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无创评估在监测炎症性肠病活动方面的功效：中国的一项前瞻性研究
DOI：
10.3748/wjg.v23.i46.8235
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发表时间：
2017-12-14
影响因子：
4.3
通讯作者：
Nie B
中科院分区：
文献类型：
--
作者：
Chen JM;Liu T;Gao S;Tong XD;Deng FH;Nie B
优化无创评估在监测炎症性肠病（IBD）内镜活动方面的功效。测量了 136 名 IBD 患者的粪便钙卫蛋白 (FC)、临床活动指数 (CDAI 或 CAI)、C 反应蛋白 (CRP)、红细胞沉降率 (ESR) 和降钙素原 (PCT)。此外，还对 25 名肠易激综合征 (IBS) 患者（作为对照）进行了 FC 测量。然后，由另外两名内镜医师使用“克罗恩病简单内镜评分”（SES-CD）确定结肠或回结肠克罗恩病（CICD）患者的内镜活动，使用Rutgeerts评分确定CD相关手术患者的内镜活动，并使用Mayo评分确定溃疡性结肠炎（UC）患者的内镜活动。通过 Mann-Whitney 检验、χ2 检验、Spearman 相关性和多元线性回归分析来评估这些评估预测内镜疾病活动性的有效性。 CD、UC 和 IBS 患者的中位 FC 水平分别为 449.6（IQR，137.9-1344.8）、497.9（IQR，131.7-118.0）和 9.9（IQR，049.7）μg/g（P < 0.001）。对于 FC、CDAI 或 CAI，CICD 和 UC 患者内镜下活动期和缓解期之间的 CRP 和 ESR 存在显着差异，但 CD 相关手术患者中则无显着差异。 SES-CD 与 FC 水平密切相关 (r = 0.802)，其次是 CDAI (r = 0.734)、CRP (r = 0.658) 和 ESR (r = 0.557)。 Mayo 评分还与 FC (r = 0.837)、CAI (r = 0.776)、ESR (r = 0.644) 和 CRP (r = 0.634) 显着相关。对于 FC，250 μg/g 的临界值表明内镜活动性炎症，对于 CICD、CD 相关手术和 UC 患者，准确度分别为 87.5%、60% 和 91.1%。此外，计算为 0.8 × FC + 4.6 × CDAI 的临床 FC 活动 (CFA) 显示 CICD 的曲线下面积 (AUC) 较高，为 0.962，而计算为 0.2 × FC + 50 × CAI 的 CFA 显示 UC 患者的 AUC (0.980) 高于 FC。此外，CICD 患者的 AUC 为 0.91，UC 患者的 AUC 为 0.96，反映了 FC 在识别临床缓解的粘膜炎症患者方面的诊断准确性。 FC 是监测 CICD 和 UC 内镜活动最有前途的无创评估。 CFA 对于 IBD 活动评估可能更准确。
To optimize the efficacy of noninvasive evaluations in monitoring the endoscopic activity of inflammatory bowel disease (IBD). Fecal calprotectin (FC), clinical activity index (CDAI or CAI), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and procalcitonin (PCT) were measured for 136 IBD patients. Also, FC was measured in 25 irritable bowel syndrome (IBS) patients that served as controls. Then, endoscopic activity was determined by other two endoscopists for colonic or ileo-colonic Crohn’s disease (CICD) with the “simple endoscopic score for Crohn’s disease” (SES-CD), CD-related surgery patients with the Rutgeerts score, and ulcerative colitis (UC) with the Mayo score. The efficacies of these evaluations to predict the endoscopic disease activity were assessed by Mann-Whitney test, χ2 test, Spearman’s correlation, and multiple linear regression analysis. The median FC levels in CD, UC, and IBS patients were 449.6 (IQR, 137.9-1344.8), 497.9 (IQR, 131.7-118.0), and 9.9 (IQR, 049.7) μg/g, respectively (P < 0.001). For FC, CDAI or CAI, CRP, and ESR differed significantly between endoscopic active and remission in CICD and UC patients, but not in CD-related surgery patients. The SES-CD correlated closely with levels of FC (r = 0.802), followed by CDAI (r = 0.734), CRP (r = 0.658), and ESR (r = 0.557). The Mayo score also correlated significantly with FC (r = 0.837), CAI (r = 0.776), ESR (r = 0.644), and CRP (r = 0.634). For FC, a cut-off value of 250 μg/g indicated endoscopic active inflammation with accuracies of 87.5%, 60%, and 91.1%, respectively, for CICD, CD-related surgery, and UC patients. Moreover, clinical FC activity (CFA) calculated as 0.8 × FC + 4.6 × CDAI showed higher area under the curve (AUC) of 0.962 for CICD and CFA calculated as 0.2 × FC + 50 × CAI showed higher AUC (0.980) for UC patients than the FC. Also, the diagnostic accuracy of FC in identifying patients with mucosal inflammation in clinical remission was reflected by an AUC of 0.91 for CICD and 0.96 for UC patients. FC is the most promising noninvasive evaluation for monitoring the endoscopic activity of CICD and UC. CFA might be more accurate for IBD activity evaluation.
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影响因子：
29.4
作者：
Ng, Siew C.;Tang, Whitney;Chan, Francis K. L.
通讯作者：
Chan, Francis K. L.
影响因子：
158.5
作者：
SCHROEDER, KW;TREMAINE, WJ;ILSTRUP, DM
通讯作者：
ILSTRUP, DM
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作者：
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通讯作者：
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影响因子：
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作者：
Oussalah, A.;Laurent, V.;Peyrin-Biroulet, L.
通讯作者：
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影响因子：
4.9
作者：
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通讯作者：
Shamir, Raanan