3种肠道疾病粪便钙卫蛋白水平变化及意义  

Changes and significance of fecal calprotectin in the diagnosis of three intestinal diseases

作　　者：苏连明[1] 贾红玲 金大伟[1] 董爱莲[1] 刘秋梅[1] 黄丽红[1] 沙瑞华[1] 刘永梁[1] 冯丹丹[2] SU Lian-ming;JIA Hong-ling;JIN Da-wei;DONG Ai-lian;LIU Qiu-mei;HUANG Li-hong;SHA Rui-hua;LIU Yong-liang;FENG Dan-dan(Department of Gastroenterology,Hongqi Hospital of Mudanjiang Medical College,Mudanjiang 157011,China)

机构地区：[1]牡丹江医学院红旗医院消化内科,黑龙江牡丹江157011 [2]牡丹江医学院研究生院,黑龙江牡丹江157011

出　　处：《中华实用诊断与治疗杂志》2018年第8期761-763,共3页Journal of Chinese Practical Diagnosis and Therapy

基　　金：黑龙江省卫生和计划生育委员会科研课题(2016-395);牡丹江市科学计划项目(Z2016S0062)

摘　　要：目的探讨炎症性肠病(inflammatory bowel disease,IBD)、肠易激综合征(irritable bowel syndrome,IBS)、大肠癌患者粪便钙卫蛋白(fecal calprotectin,FC),血清C反应蛋白(C-reactive protein,CRP)、癌胚抗原(carcinoembryonic antigen,CEA)水平变化,及FC联合CRP、CEA在IBD、大肠癌中的诊断价值。方法肠道疾病患者90例,其中30例IBD患者为IBD组,30例IBS患者为IBS组,30例大肠癌患者为大肠癌组,于肠镜活检或手术前检测粪便FC,血清CRP及CEA水平,并进行比较;绘制ROC曲线,分析FC单独及联合血清CRP诊断IBD的效能,FC单独及联合血清CEA诊断大肠癌的价值。结果 IBD组粪便FC[811.43(576.66,938.73)μg/g]、血清CRP[(37.23±36.46)mg/L]水平高于IBS组[29.97(17.01,39.24)μg/g、(1.56±1.21)mg/L]和大肠癌组[211.23(88.02,346.47)μg/g、(12.37±10.59)mg/L],大肠癌组高于IBS组(P<0.05);大肠癌组CEA[(16.53±14.99)μg/L]水平高于IBD组[(2.22±1.01)μg/L]和IBS组[(2.07±1.23)μg/L](P<0.05),IBD组与IBS组比较差异无统计学意义(P>0.05);粪便FC以378.8μg/g为最佳截断值,诊断IBD的AUC为0.939(95%CI:0.887~0.991,P<0.001),灵敏度为86.7%,特异度为90.0%;以55.99μg/g最佳截断值,诊断大肠癌的AUC为0.516(95%CI:0.396~0.636,P=0.807),灵敏度为83.3%,特异度为50.0%;FC联合CRP诊断IBD的AUC为0.954,灵敏度为90.0%,特异度为95.0%;FC联合CEA诊断大肠癌的AUC为0.905,灵敏度为73.3%,特异度为95.0%。结论粪便FC、血清CRP可用于IBD、IBS和大肠癌的初步筛查,联合血清CRP、CEA检测可分别提高IBD、大肠癌诊断的准确性。Objective To investigate the changes of fecal calprotectin （FC）, serum C-reactive protein （CRP） and carcinoembryonic antigen （CEA） in inflammatory bowel disease （IBD）, irritable bowel syndrome （IBS） and colorectal cancer, and the values of FC plus CRP and FC plus CEA to the diagnosis of IBD and colorectal cancer. Methods Ninety patients with intestinal diseases were divided into 30 patients with IBD （IBD group）, 30 patients with IBS （IBS group） and 30 patients with colorectal cancer （cancer group）. The levels of FC, serum CRP and CEA were detected before colonoscopy or surgery and were compared. The ROC curve was used to analyze the efficacies of FC alone and combined with serum CRP on the diagnosis of IBD, and the values of FC alone and combined with serum CEA to the diagnosis of co[orectal cancer. Results The levels of FC and CRP were significantly higher in IBD group （（811. 43 （576. 66, 938.73）μg/g, （37. 23±36.46）mg/L） than those in IB Sgroup （（29.97（17.01, 39.24）μg/g, （1. 564±1. 21）mg/L） and cancer group （（211.23（88.02, 346.47）μg/g, （12. 37±10.59）mg/L） （P〈0.05）, and higher in cancer group than those in IBS group （P〈0.05）. The CEA level was significantly higher in cancer group （（16. 53±14.99）μg/L） than that in IBD group （（2. 22±1.01）μg/L） and IBS group （（2. 07±1.23）μg/L） （P〈0.05）, and there was no significant difference between IBD group and IBS group （P〉0.05）. When the optimal cut-off of FC was 378. 8 μg/g, the AUC for the diagnosis of IBD was 0. 939（95%CI：0. 887-0. 991, P〈0. 001）, with the sensitivity and specificity of 86.7% and 90.0%.When the optimal cut-off of FC was 55.99 μg/g, the AUC for colorectal cancer was 0. 516（95%CI：0. 396-0. 636, P= 0. 807）, with the sensitivity and specificity of 83.3% and 50.0%. The AUC of the joint detection of FC and CRP for IBD was 0. 954, and the sensitivity and specificity were 90.0% and 95.0%. The AUC of joint detection of

关 键 词：炎症性肠病 肠易激综合征 大肠癌 钙卫蛋白 C反应蛋白 癌胚抗原 

分 类 号：R574[医药卫生—消化系统] R735.34[医药卫生—内科学]