粪便新喋呤及钙卫蛋白对炎症性肠病活动性的诊断价值  

Clinical diagnostic value of fecal neopterin and calprotectin on the activity of inflammatory bowel disease

作　　者：叶院宁 余纳[1] 孙文荣[1] 张钰坪 陆恒[1] 吴晓辰[1] 王少东[1] 汪芳裕[1] 

机构地区：[1]南方医科大学金陵医院(南京军区南京总医院)消化内科,南京医学硕士研究生210002

出　　处：《医学研究生学报》2016年第2期159-164,共6页Journal of Medical Postgraduates

基　　金：国家自然科学基金(81270453)

摘　　要：目的粪便生物标志物目前已成为评价和监测炎症性肠病(inflammatory bowel disease,IBD)活动性的一项重要工具。文中探讨粪便新喋呤(fecal neopterin,FNP)及钙卫蛋白(fecal calprotectin,FCP)对IBD活动性的诊断价值,并与作为炎症标志物的血清C-反应蛋白(C-reactive protein,CRP)进行比较。方法研究共纳入2014年5月至2015年2月间于南京军区南京总医院消化内科住院并行结肠镜检查的IBD患者151例,其中克罗恩病(Crohn's disease,CD)患者84例、溃疡性结肠炎(ulcerative colitis,UC)患者67例。所有IBD患者在结肠镜检查前留取2g以上新鲜粪便标本和2m L新鲜血液,通过用酶联免疫吸附试验(ELISA)检测FNP与FCP浓度,同时检测血清CRP浓度。CD疾病活动性评价采用CD活动指数(Crohn's disease activity index,CDAI),UC疾病活动性评价采用改良的Mayo评分。比较各标志物与IBD活动性评分的相关性,各标志物诊断IBD活动性的最佳临界值,以及敏感性、特异性,并绘制操作者受试曲线。同时纳入50例结肠镜检查正常的健康体检者作为对照组,并于结肠镜检查前留取2g以上的新鲜粪便标本。结果 IBD患者FNP和FCP浓度均显著高于对照组(P<0.05)。活动期IBD患者FNP、FCP浓度均显著高于缓解期患者(P<0.001)。FNP、FCP与CD患者CDAI的相关系数分别为0.55和0.59(P<0.001),与UC患者改良的Mayo评分的相关系数分别为0.74和0.77(P<0.001)。血清CRP与CD和UC患者疾病活动性评分的相关系数分别为0.49和0.60(P<0.001)。FNP和FCP诊断CD活动性的曲线下面积(AUC)分别为0.75和0.80,诊断UC活动性的AUC分别为0.85和0.90,血清CRP诊断CD和UC疾病活动性的AUC分别为0.65和0.74,FNP与FCP联合诊断CD和UC疾病活动性的AUC分别为0.85和0.92。结论 FNP是一种可靠评价IBD活动性的非侵入性生物标志物,具有与FCP相似的IBD活动性评价准确性,临床上可以通过联合检测FNP和FCP来实时评价IBD患者的疾病活动状态。Objective Fecal biomarkers have emerged as an important tool for assessing and monitoring disease activity in patients with inflammatory bowel disease（ IBD）. We aimed to investigate the diagnostic value of fecal neopterin and calprotectin in patients with active inflammatory bowel disease and made comparison with that of serum C-reactive protein（ CRP）. Methods A total of 151 consecutive patients with IBD（ 84 CD and 67 UC） provided 2gram fecal samples for the measurement of fecal neopterin（ FNP） and calprotectin（ FCP） concentrations and 2 milliliter blood samples for the serum C-reactive protein measurement before undergoing a colonoscopy. ELISA was applied in the measurement. Clinical disease activities were scored independently according to the Best Crohn＇ s Disease Activity Index（ CDAI） in patients with CD,while the Modified Mayo Scores in patients with UC. Comaprison was made in the relativity of each fecal marker and IBD activity score,the optimum value of diagnosing IBD acitivity as to each fecal marker,as well as sensitivity,specificity,moreover,receiver operating characteristic curve（ ROC） was drawn. 50 healthy volunteers who received a normal colonoscopy were also enrolled as the control group and asked to give a 2 gram fresh stool sample. Results The FNP and FCP concentrations in patients with IBD were significantly higher than those in healthy control group（ P〈0. 05）. Both FNP and FCP concentrations differed significantly in clinically active IBD when compared with those in patients with inactive disease（ P〈0. 001）. In CD patients,the correlation coefficients of FNP and FCP with CDAI were0. 55 and 0. 59,respectively（ P〈0. 001）. In UC patients,the correlation coefficients of FNP and FCP with Mayo scores were 0. 74 and 0. 77,respectively（ P〈0. 001）. The correlation coefficients of serum CRP in CD and UC patients with clinical scores were 0. 49 and 0. 60,respectively（ P〈0. 001）. The area under the ROC curve（ AUC） of FNP and FCP for the diagnos

关 键 词：粪便新喋呤 粪便钙卫蛋白 炎症性肠病 疾病活动性诊断 

分 类 号：R574[医药卫生—消化系统]