Role of fecal calprotectin testing to predict relapse in teenagers with inflammatory bowel disease who report full disease control
Role of fecal calprotectin testing to predict relapse in teenagers with inflammatory bowel disease who report full disease control
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DOI：
10.1002/ibd.22896
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发表时间：
2012-11-01
影响因子：
4.9
通讯作者：
van Rheenen, Patrick F.
中科院分区：
文献类型：
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作者：
van Rheenen, Patrick F.
背景：患有炎症性肠病的青少年接受定期随访，以观察可能表明复发的症状。目前的疾病活动性经常使用儿童溃疡性结肠炎活动指数（PUCAI）和儿童克罗恩病活动指数（PCDAI）进行评估。我们研究了粪便钙卫蛋白和C反应蛋白（CRP）预测无症状青少年复发的能力。其次，我们检查了钙卫蛋白和CRP作为附加试验是否提高了PUCAI或PCDAI预测复发的特异性。研究方法：我们收集了62名连续青少年（31名克罗恩病患者和31名溃疡性结肠炎患者）的数据，他们在连续两次门诊就诊中的疾病控制程度在90%和100%之间。在基线时测量钙卫蛋白、PUCAI或PCDAI和CRP。主要结局是基线后3个月内症状复发，需要引入类固醇、独家肠内营养或氨基水杨酸剂量递增。结果：15名青少年（24%）在基线3个月内出现症状复发。基于受试者工作特征曲线，区分高风险患者和低风险患者的最佳钙卫蛋白临界点为500 μ g/g。PUCAI或PCDAI预测42%（11/26）的青少年复发，阳性结果（评分=10分），而阴性PUCAI或PCDAI结果将复发风险降低至11%（4/36）。钙卫蛋白检测阳性的青少年有53%（10/19）的风险在3个月内进展为症状复发，而钙卫蛋白检测阴性的青少年有12%（5/43）的风险出现症状复发。阳性CRP结果（临界值10 mg/L）的复发风险为50%（4/8），而阴性CRP结果几乎没有降低风险（从24%降至21%（11/53））。作为PUCAI或PCDAI后的附加检测，钙卫蛋白检测限制了假阳性的数量，从而提高了检测胃肠道炎症的特异性：60%（9/15）的阳性一致性检测结果的青少年进展为症状复发。阴性一致性将复发风险降低至10%（3/32）。在PUCAI或PCDAI后，CRP作为附加试验的贡献很小：5名一致性试验阳性的青少年中有2名进展为症状复发（40%）。结论：与CRP不同，粪便钙卫蛋白作为PUCAI或PCDAI后的附加试验有助于识别临床前复发。这可能有助于确定哪些青少年在疾病轻微时需要强化治疗，而不是在临床上明显复发时。需要进一步研究以确定粪便钙卫蛋白检测对治疗管理和结果的影响。（Inflamm Bowel Dis 2012;）
Background: Teenagers with inflammatory bowel disease undergo regular follow-up visits to watch for symptoms that may indicate relapse. Current disease activity is frequently estimated with the use of the Pediatric Ulcerative Colitis Activity Index (PUCAI) and the Pediatric Crohn's Disease Activity Index (PCDAI). We examined the capacity of fecal calprotectin and C-reactive protein (CRP) to predict relapse in teenagers who report no symptoms. Second, we examined whether calprotectin and CRP as an add-on test improve the specificity of PUCAI or PCDAI to predict relapse. Methods: We collected data of 62 consecutive teenagers (31 with Crohn's disease and 31 with ulcerative colitis) who scored their degree of disease control between 90 and 100% on two successive outpatient clinic visits. Calprotectin, PUCAI or PCDAI, and CRP were measured at baseline. Primary outcome was symptomatic relapse within 3 months of baseline, necessitating the introduction of steroids, exclusive enteral nutrition, or an aminosalicylate dose escalation. Results: Fifteen teenagers (24%) developed symptomatic relapse within 3 months of baseline. Based on the receiver operating characteristic curve, the optimum calprotectin cutpoint to differentiate high from low risk patients was 500 mu g/g. The PUCAI or PCDAI predicted relapse in 42% (11/26) of teenagers with a positive result (score =10 points), while a negative PUCAI or PCDAI result reduced the risk of relapse to 11% (4/36). Teenagers with a positive calprotectin test had a 53% (10/19) risk of progressing to symptomatic relapse within 3 months, whereas a negative calprotectin result gave a 12% (5/43) risk of symptomatic relapse. A positive CRP result (cutoff 10 mg/L) gave a 50% (4/8) risk of relapse, whereas a negative CRP result hardly reduced the risk compared with the pretest probability (from 24% to 21% (11/53)). As an add-on test after PUCAI or PCDAI, the calprotectin test limited the number of false positives and thus increased the specificity to detect gastrointestinal inflammation: 60% (9/15) of teenagers with positive concordant test results progressed to symptomatic relapse. Negative concordance reduced the risk of relapse to 10% (3/32). CRP contributed little as add-on test after PUCAI or PCDAI: two of five teenagers with positive concordant tests progressed to symptomatic relapse (40%). Conclusions: Unlike CRP, fecal calprotectin as an add-on test after PUCAI or PCDAI facilitates recognition of preclinical relapse. This could help to identify teenagers who require treatment intensification at the time of minimal disease rather than at the time of clinically overt relapse. Further studies are warranted to determine the impact of fecal calprotectin testing on treatment management and outcome. (Inflamm Bowel Dis 2012;)