Fecal lactoferrin for diagnosis of symptomatic patients with ileal pouch-anal anastomosis
Fecal lactoferrin for diagnosis of symptomatic patients with ileal pouch-anal anastomosis
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DOI：
10.1053/j.gastro.2004.02.012
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发表时间：
2004-05-01
期刊：
影响因子：
29.4
通讯作者：
Lashner, BA
中科院分区：
文献类型：
--
作者：
Parsi, MA;Shen, B;Lashner, BA
背景与目的：回肠袋-肛门吻合术（IPAA）患者大便频率增加、尿急和腹痛可能是由于炎症性疾病，包括袋炎、ciffitis或Crohn's病，或非炎症性疾病，如易激袋综合征。区分这些实体需要眼袋内窥镜检查和活检。无创诊断方法是优选的。方法：60名因炎症性肠病而接受IPAA治疗的连续受试者测量了粪便乳铁蛋白和α - 1抗胰蛋白酶，并进行了袋内窥镜活检，在前瞻性横断面研究中计算了袋炎疾病活动性指数。结果：有症状的炎症患者的粪便乳铁蛋白浓度（中位数，176.0马克/毫升，四分位间距[IQR] 79.0-450.8）明显高于无炎症患者（中位数，4.8马克/毫升，IQR, 1.2-1.1.0）或无症状患者（中位数，7.8马克/毫升，IQR, 1.4-12.9）， P < 0.001。在7马克杯/毫升的临界值水平下，粪便乳铁蛋白可区分肠易激袋综合征患者与袋炎、袋炎或克罗恩病患者，敏感性为100%，特异性为85%。粪便α - 1抗胰蛋白酶不能区分有和没有炎症的症状患者。结论：粪乳铁蛋白可作为评价IPAA症状患者的一种敏感、无创的初始筛选试验。如果粪便乳铁蛋白水平低(
Background & Aims: Increased stool frequency, urgency, and abdominal pain in patients with ileal pouch-anal anastomosis (IPAA) may be due to inflammatory conditions, including pouchitis, ciffitis, or Crohn's disease or noninflammatory conditions such as irritable pouch syndrome. Distinction among these entities requires pouch endoscopy and biopsy. Noninvasive means of diagnosis are preferable. Methods: Sixty consecutive subjects with IPAA for inflammatory bowel disease had measurements of fecal lactoferrin and alpha1-antitrypsin and underwent pouch endoscopy with biopsy, with calculation of the pouchitis disease activity index in a prospective cross-sectional study. Results: Symptomatic patients with an inflammatory condition had significantly higher fecal lactoferrin concentrations (median, 176.0 mug/mL, interquartile range [IQR] 79.0-450.8) compared with those with a noninflammatory condition (median, 4.8 mug/mL; IQR, 1.2-1.1.0) or those who were asymptomatic (median, 7.8 mug/mL; IQR, 1.4-12.9), P < 0.001. At a cutoff level of 7 mug/mL, fecal lactoferrin could distinguish patients with irritable pouch syndrome from those with pouchitis, cuffitis, or Crohn's disease with a sensitivity of 100% and specificity of 85%. Fecal alpha1-antitrypsin was not able to distinguish symptomatic patients with and without an inflammatory condition. Conclusions: Fecal lactoferrin can serve as a sensitive and noninvasive initial screening test in an algorithm for evaluation of symptomatic patients with IPAA. If fecal lactoferrin levels are low (