Dig Liver Dis: 肠切除术后前三个月内粪便钙卫蛋白水平的变化预示着克罗恩病的内镜术后复发

2020-08-13 MedSci原创 MedSci原创

钙卫蛋白是一种来源于中性粒细胞和巨噬细胞的含钙蛋白,其表达具有组织或细胞特异性,可作为急性炎性细胞活化的标志物。它可以存在于血浆和粪便中。

        钙卫蛋白是一种来源于中性粒细胞和巨噬细胞的含钙蛋白,其表达具有组织或细胞特异性,可作为急性炎性细胞活化的标志物。它可以存在于血浆和粪便中。2005年英国肠胃病学年会将钙卫蛋白作为一个新的无创性诊断指标,其中粪便钙卫蛋白可用于区别炎症性肠病(简称IBD,主要包括克罗恩病(CD)和溃疡性结肠炎(UC))和肠易激综合征(IBS),因此其作用在监测炎症性肠病炎症活动中越来越重要。

        研究显示,粪便钙卫蛋白检查可用于评估CD术后患者内镜复发情况,且作用明显优于C-反应蛋白。本项研究旨在评估术后前三个月内的连续粪便钙卫蛋白(Fcal)水平与CD内镜下的复发的关系。

     

DOI:https://doi.org/10.1016/j.dld.2020.03.020

        在本项试验中研究人员对纳入的患者进行了随机对照,研究人员将接受手术的CD患者随机分为接受2.5 mg / kg /天的硫唑嘌呤联合口服姜黄素(3 g /天)治疗或接受安慰剂治疗。在术后,术后一个月(M1)和术后3个月(M3)时测量Fcal水平。术后6个月(M6)内镜复发(POR)定义为Rutgeerts指数≥i2b。

 

        纳入的48例患者中,基线时的中位Fcal水平(p  = 0.15),M1( p  = 0.44)和M3( p = 0.28)没有显着差异 。在M6时有或没有POR的患者,术后三个月的粪便动力学差异显着(p=0.021)。内镜下POR患者的基线Fcal水平与M3水平之间的中位数变化(ΔFcalM3-M0)显着高于未复发的患者( p = 0.01)。ΔFcalM3–M0> + 10%表现出预测M6内镜POR的最佳性能(AUC = 0.73,灵敏度= 64.7%[41.1-82.7],特异性= 87.5%[68.0-96.3],阴性预测值= 77.8%[ 57.5–91.4]和阳性预测值= 78.6%[49.2–95.3])。

图:内镜下复发的CD患者粪钙卫蛋白水平高

        最后作者说道:行回肠结肠切除后的CD患者术后前三个月内的粪便变化是CD患者早期内镜POR的有希望的预测指标。

 

原始出处:

Mathilde Boube. Et al. Variation of faecal calprotectin level within the first three months after bowel resection is predictive of endoscopic postoperative recurrence in Crohn's disease. Dig Liver Dis.2020.

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    2020-08-15 Homburg

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