Fecal Calprotectin More Accurately Predicts Endoscopic Remission of Crohn's Disease than Serological Biomarkers Evaluated Using Balloon-assisted Enteroscopy
Fecal Calprotectin More Accurately Predicts Endoscopic Remission of Crohn's Disease than Serological Biomarkers Evaluated Using Balloon-assisted Enteroscopy
复制标题
DOI：
10.1097/mib.0000000000001202
复制
发表时间：
2017-11-01
影响因子：
4.9
通讯作者：
Kinoshita, Yoshikazu
中科院分区：
文献类型：
--
作者：
Kawashima, Kousaku;Ishihara, Shunji;Kinoshita, Yoshikazu
背景：粪钙保护素(Fc)已成为克罗恩病(CD)内窥镜下缓解的可靠替代标记物，主要通过回肠结肠镜对其进行评估。本研究旨在阐明气囊辅助小肠镜检查(BAE)结果预测CD患者内窥镜下病情缓解的可行性，并与传统的血清生物标志物进行比较。方法：前瞻性研究CD患者，术前采集粪便和血液样本。我们对CD使用了改良的简单内窥镜评分，其中从传统的CD简单内窥镜评分中去掉了参数“存在狭窄”。结果：53例CD患者共进行了70次BAE治疗，并对其进行了评价。FC预测内窥镜缓解的曲线下面积为0.93，最佳临界值为252.9 mg/g，敏感性为96%，特异性为83%，高于C反应蛋白、白蛋白、白细胞和血小板计数(分别为0.76、0.66、0.39和0.65)。Fc曲线下面积在回肠和回结肠病变部位预测CD的准确性较高(分别为204.2和253.7 mg/g)，也高于血清学标志物的曲线下面积。结论：FC对CD的预测准确性高于C反应蛋白、白蛋白、白细胞和血小板计数。即使在小肠CD中，FC也可能是比血清学生物标志物更可靠的内窥镜缓解的替代标志物。
Background: Fecal calprotectin (FC) has emerged as a reliable surrogate marker of endoscopic remission in Crohn's disease (CD), which has been mainly evaluated using ileocolonoscopy. We conducted this study to clarify the predictability of FC level for predicting endoscopic remission using balloon-assisted enteroscopy (BAE) findings in patients with CD and compare with that of conventional serological biomarkers.Methods: Patients with CD scheduled to undergo BAE were prospectively enrolled, and fecal and blood samples collected before the procedures. We used a modified simple endoscopic score for CD, in which the parameter "presence of narrowing" was removed from conventional simple endoscopic score for CD. Endoscopic remission was defined as modified simple endoscopic score for CD 0 to 2.Results: Seventy BAE procedures were performed in 53 patients with CD and evaluated. The area under the curve in receiver operating characteristic curve analysis of FC to predict endoscopic remission was 0.93, with an optimal cut-off value of 252.9 mg/g, and 96% sensitivity and 83% specificity, which was higher than that for C-reactive protein, albumin, white blood cell count, and platelet count (0.76, 0.66, 0.39, and 0.65, respectively). The area under the curve of FC for predicting endoscopic remission was high in patients with ileal and ileocolonic disease location (0.86 and 0.96, cut-off values 204.2 and 253.7 mg/g, respectively), and also higher than the area under the curve values of serological markers.Conclusions: BAE findings showed that FC was more accurate for predicting endoscopic remission in CD than C-reactive protein, albumin, white blood cell count, and platelet count. Even in small-bowel CD, FC may be a more reliable surrogate marker of endoscopic remission than serological biomarkers.