Faecal calprotectin in the assessment of Crohn's disease activity

被引:64
作者
Gaya, DR
Lyon, TDB
Duncan, A
Neilly, JB
Han, S
Howell, J
Liddell, C
Stanley, AJ
Morris, AJ
Mackenzie, JF
机构
[1] Glasgow Royal Infirm, Dept Gastroenterol, Glasgow G4 0SF, Lanark, Scotland
[2] Glasgow Royal Infirm, Dept Biochem, Glasgow G4 0SF, Lanark, Scotland
[3] Glasgow Royal Infirm, Dept Nucl Med, Glasgow G4 0SF, Lanark, Scotland
关键词
D O I
10.1093/qjmed/hci069
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: Clinical and laboratory assessment of activity in Crohn's disease (CD) correlate poorly with endoscopic findings. Calprotectin is a calcium-binding protein abundant in neutrophil cytosol, and extremely stable in faeces. Faecal calprotectin (FC) is an excellent surrogate marker of neutrophil influx into the bowel lumen. Aim: To assess whether FC concentration from a spot stool sample reliably detects active inflammation in patients with CD. Design: Cross-sectional comparative study. Methods: Subjects had a previously confirmed diagnosis of CD and were suspected on clinical grounds to be in the midst of a relapse. Thirty-five entered the study; they underwent radiolabelled white cell scanning (WCS) and had a stool sample collected for calprotectin measurement on the same day. A Crohn's disease activity index (CDAI) was also calculated for each. The WCS scans were scored at six standard sites to give a mean total, 'extent', 'severity' and 'combined extent and severity' scores. Results: FC was significantly and positively correlated with mean total (r = 0.73, p < 0.001), 'extent' (r = 0.71, p < 0.001), 'severity' (r = 0.64, p < 0.001) and combined 'extent and severity' WCS scores (r = 0.71, p < 0.001). A cut-off of faecal calprotectin > 100 mu g/g gave a sensitivity of 80%, specificity of 67%, positive predictive value of 87% and a negative predictive value of 64% in identifying those with and without any inflammation on WCS. There was, however, no significant correlation between CDAI and mean total WCS score (r = 0.21, p = 0.24), nor between CDAI and FC (r = 0.33, p = 0.06). Discussion: While the CDAI does not accurately reflect inflammatory activity in CD, a one-off FC reliably detects the presence or absence of intestinal inflammation in adult patients with CD, compared to WCS.
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页码:435 / 441
页数:7
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