粪便钙卫蛋白对溃疡性结肠炎镜下活动及严重程度的评估价值

摘要

目的 侵入性的肠镜检查是评估溃疡性结肠炎(UC)患者肠道严重程度及黏膜愈合的重要方法.文中旨在探讨非侵入性指标粪便钙卫蛋白(FC)对判断UC镜下活动及重度UC的优势,并分析FC与内镜下评分的相关性. 方法 回顾性分析2016年1月至2017年9月于南京军区南京总医院消化科住院的70例UC患者资料,根据UC内镜严重程度指数(UCEIS)分为镜下缓解组[黏膜愈合(n=12,UCEIS=0分)、黏膜病变(n=10,UCEIS=1分)]、镜下活动组[轻-中度(n=30, UCEIS为2~6分)、重度(n=18,UCEIS为7~8分)].绘制ROC曲线分析各项指标(FC、PCT、IL-6等)对判断镜下活动期及重度时的预测效能,同时比较各指标与 UCEIS的相关性. 结果 镜下活动组 FC[828.5(416.6,1079.7)μg/g]、PCT[0.03 (0.02,0.06)μg/L]、IL-6[13.4(7.32,21.45)ng/L]均显著高于镜下缓解组[43.4(9.4,91.4)μg/g、0.02(0.02,0.03)μg/L、5.82 (5.14,6.73)ng/L],差异有统计学意义(P<0.001).镜下活动组患者中,重度者FC[1117.1(916.5,1492.4)μg/g]、IL-6[18.18 (12.72,33.25)ng/L]显著高于轻-中度者[622.4(218.7,924.2)μg/g、8.27(7.08,16.60)ng/L].当FC>175.6 μg/g时对诊断UC镜下活动期具有较高的准确性,其敏感性、特异性、阳性预测值及阴性预测值分别为87.50%、90.91%、95.45%和76.92%;当FC>781.1 μg/g时对诊断重度镜下活动期具有较高的准确性,其敏感性、特异性、阳性预测值及阴性预测值分别为88.89%、73.33%、66.66%和91.66%.FC、PCT、IL-6、CRP、ESR、WBC及PLT与UCEIS呈正相关(P<0.001),而HB、ALB水平与UCEIS呈负相关(P<0.001). 结论 FC是一种判断UC镜下活动期和重度UC的较好指标.FC可作为替代内镜检查对UC进行病情监测的非侵入性指标.%Objective The invasive colonoscopy is an important method for evaluating the severity of intestine and the muco-sal healing in ulcerative colitis(UC)patients. The aim of this study was to investigate the advantage of fecal calprotectin(FC)in diagnosing UC endoscopic activity and severity and analyze the FC correlation with endoscopic scores. Methods A total of 70 UC in-patients in our hospital from January 2016 to September 2017 were retrospectively analyzed and categorized into endoscopic remission UC [mucosal healing(n=12),mucosal lesion(n=10)]and endoscopic active UC[mild-moderate(n=30)and severe(n=18)]according to UC Endoscopic Index of Severity(UCEIS).The ROC curve was used to analyze the predictive efficacy of each laboratory indicator to identify endoscopically active UC and severe UC and evaluate the correlation of UCEIS with all these indicators. Results In UC pa-tients,the levels of FC[828.5(416.6,1079.7)μg/g],PCT[0.03(0.02,0.06)μg/L]and IL-6[13.4(7.32,21.45)ng/L]were sig-nificantly higher in endoscopically active UC than those[43.4(9.4,91.4)μg/g、0.02(0.02,0.03)μg/L、5.82(5.14,6.73)ng/L]in remission and the levels of CRP,ESR,WBC count and PLT count also increased significantly,while HB and ALB levels were signifi-cantly lower than those in remission(all P value<0.001).In endoscopically active UC patients,the levels of FC[1117.1(916.5,1492. 4)μg/g]and IL-6[18.18(12.72,33.25)ng/L]were significantly higher than those of mild-moderate UC[622.4(218.7,924.2)μg/g,8.27(7.08,16.60)ng/L](P<0.05)and the levels of CRP,ESR and WBC also increased significantly(P<0.05),while the ALB showed a significant lower level(P=0.002). When FC>175.6 μg/g,it was of higher accuracy in diagnosing UC endoscopic activity and the sensitivity,specificity,positive predictive value and negative predictive value were respectively 87.50%,90.91%,95.45%and 76.92%;When FC>781.1 μg/g,it was of higher accuracy in diagnosing severe UC and the sensitivity,specificity,positive predic-tive value and negative predictive value were respectively 88.89%,73.33%,66.66% and 91.66%. The levels of FC,PCT,IL-6, CRP,ESR,WBC and PLT all presented positive correlation with UCEIS(P<0.001),while the HB and ALB levels showed a negative correlation with UCEIS(P<0.001). Conclusion FC is a good indicator to judge UC endoscopic activity and severe UC. FC can be used as a non-invasive and surrogate marker for endoscopy to monitor UC disease activity in clinical practice.