Clin Gastroenterology H: 粪便钙卫蛋白在诊断后12个月内正常化与克罗恩病患者疾病进展风险降低相关

2020-08-15 MedSci原创 MedSci原创

由于克罗恩病具有反复发作的特点,因此大多数患者需要长期服用治疗药物以维持疾病的缓解,防止复发。

        由于克罗恩病具有反复发作的特点,因此大多数患者需要长期服用治疗药物以维持疾病的缓解,防止复发。病情活动状况决定了治疗方案,因此患者需要定期评估病情。

        内镜检查是评估IBD病情活动的金标准,可以非常直观的观察肠道粘膜表现并且可以病理活检。但是内镜检查是侵入性操作,检查前患者需要空腹,且费用相对较高,短期内重复监测不易被接受。

        粪钙卫蛋白含量在IBD 患者粪便中特异性升高并能长期保持稳定, 在常温下可以保存1周。其与肠镜相关性较好, 具有取样方便,敏感性及特异性高,可短期内重复检测、易于被无症状人群接受等优点, 特别在判断疾病活动及复发方面具有指导意义。

        最近,研究人员指出粪钙卫蛋白不光可以作为炎症变化的生物指标,也可以作为疾病预后的预测指标。有研究人员对克罗恩病患者诊断后一年内的粪钙卫蛋白水平进行长期随访后发现,粪钙卫蛋白的正常化与疾病良好的预后有关。

DOI:https://doi.org/10.1016/j.cgh.2020.08.022

        研究人员将一家医疗中心的2005年到2017年间诊断出的所有CD患者均进行了回顾性分析,将那些诊断时的粪钙卫蛋白(FC)测量值≥250μg/ g的患者,且在诊断的前12个月内和随访的> 12个月内也至少进行了1次随访FC测量的患者纳入本项研究。主要观察终点是首次疾病进展的时间(蒙特利尔疾病行为从B1到B2 / 3,B2到B3或新的肛周疾病的进展复合;与CD相关的手术发生;或与CD相关的住院治疗的出现)。

        总共375名患者被纳入研究,中位随访时间为5.3年(四分位间距为3.1-7.4年)。在43.5%的患者中,在诊断后的12个月内实现了FC的正常化。正常FC患者的复合疾病进展风险显着降低(危险比[HR]为0.36; 95%CI为0.24–0.53; P <.001)。他们达到任何单独的进展终点的风险也较低(蒙特利尔行为或新的肛周疾病的进展HR,0.22; 95%CI,0.11-0.45;P <.001;住院HR,0.33; 95%CI,0.21 –0.53;P <.001;手术HR,0.39; 95%CI,0.19-0.78;P= .008)。

        总之,粪便钙卫蛋白检查可为克罗恩病的诊断、鉴别及随访提供可靠依据,值得推广应用。

 

原始出处:

N. Plevris, MRCP. Et al. Normalization of Fecal Calprotectin Within 12 Months of Diagnosis is Associated with Reduced Risk of Disease Progression in Patients with Crohn’s Disease. Clin Gastroenterology H. 2020.

 

 

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    2020-09-08 许安
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    2020-08-17 1de64367m34(暂无匿称)

    长知识了

    0

  7. 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encryptionId=fde528896bd, topicName=克罗恩病)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a12645, createdName=智慧医人, createdTime=Sat Aug 15 09:43:55 CST 2020, time=2020-08-15, status=1, ipAttribution=)]
    2020-08-17 Homburg
  8. 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    2020-08-15 智慧医人

    #钙卫蛋白#检查可为#克罗恩病#的诊断、鉴别及随访提供可靠依据,不过在中国仍然需要验证,另外,还要考虑钙卫蛋白的高低与克罗恩病的严重程度之度的关联

    0

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