Consecutive Monitoring of Fecal Calprotectin and Lactoferrin for the Early Diagnosis and Prediction of Pouchitis after Restorative Proctocolectomy for Ulcerative Colitis
Consecutive Monitoring of Fecal Calprotectin and Lactoferrin for the Early Diagnosis and Prediction of Pouchitis after Restorative Proctocolectomy for Ulcerative Colitis
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DOI：
10.1038/ajg.2015.129
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发表时间：
2015-06-01
影响因子：
9.8
通讯作者：
Matsumoto, Koichi
中科院分区：
文献类型：
--
作者：
Yamamoto, Takayuki;Shimoyama, Takahiro;Matsumoto, Koichi
目的：本前瞻性研究旨在评价连续监测粪便钙卫蛋白和乳铁蛋白对溃疡性结肠炎（UC）修复性直肠结肠切除术后结肠袋炎的早期诊断和预测的意义。回肠造口闭合后，每2个月收集粪便样本用于测量钙卫蛋白和乳铁蛋白，直至12个月。当患者出现提示结肠袋炎的症状时，立即进行内窥镜检查。所有无症状患者在12个月时接受内镜检查。结肠袋炎定义为结肠袋炎疾病活动指数评分≥ 7。结果：在12个月期间，10例（17%）患者发生结肠袋炎。在结肠袋炎患者中，粪便钙卫蛋白和乳铁蛋白水平在结肠袋炎诊断前2个月已经升高。相比之下，这些粪便生物标志物保持在低水平，并且它们在没有结肠袋炎的患者中没有显著变化。钙卫蛋白的临界值为56 μ g/g，预测结肠袋炎的灵敏度为100%，特异性为84%，而乳铁蛋白的临界值为50 μ g/g，灵敏度为90%，特异性为86%。在内镜检查时，平均钙卫蛋白和乳铁蛋白水平显着高于pouchitis.CONCLUSIONS：粪便钙卫蛋白和乳铁蛋白水平升高的患者与pouchitis. CONCLUSIONS：出现后恢复性直肠结肠切除术UC的pouchitis的显着预测。这些粪便生物标志物的连续监测对于结肠袋炎的早期诊断是有用的。
OBJECTIVES: This prospective study was conducted to evaluate the significance of consecutive monitoring of fecal calprotectin and lactoferrin for the early diagnosis and prediction of pouchitis after restorative proctocolectomy for ulcerative colitis (UC).METHODS: Sixty patients who had ileostomy closure following total proctocolectomy and ileal pouch-anal anastomosis for UC were included. Stool samples were collected for the measurement of calprotectin and lactoferrin every 2 months up to 12 months after the ileostomy closure. When patients had symptoms suggestive of pouchitis, endoscopic examination was immediately undertaken. All asymptomatic patients underwent endoscopy at 12 months. Pouchitis was defined as a pouchitis disease activity index score of >= 7.RESULTS: During the 12 months, 10 patients (17%) developed pouchitis. In patients with pouchitis, fecal calprotectin and lactoferrin levels were elevated already 2 months before the diagnosis of pouchitis. In contrast, these fecal biomarkers remained at low levels, and they did not change significantly in patients without pouchitis. A cutoff value of 56 mu g/g for calprotectin had a sensitivity of 100% and a specificity of 84% to predict pouchitis, whereas a cutoff value of 50 mu g/g for lactoferrin had a sensitivity of 90% and a specificity of 86%. At the time of endoscopy, the median calprotectin and lactoferrin levels were significantly higher in patients with pouchitis than those without pouchitis.CONCLUSIONS: Elevated fecal calprotectin and lactoferrin levels appeared to be signifi cant predictors of pouchitis after restorative proctocolectomy for UC. Consecutive monitoring of these fecal biomarkers is useful for the early diagnosis of pouchitis.