粪便钙卫蛋白检测在肠易激综合征鉴别诊断中的意义

目的:评价粪便钙卫蛋白检测作为一种非侵入性检查方法,在肠易激综合征(irritable bowel syndrome,IBS)确诊前排除相关器质性疾病诊断中的价值.方法:研究对象240例,包括IBS组60例,大肠癌组60例,慢性炎症组60例,正常对照组60例,在结肠镜检查一周内或手术前一周内留取5 g粪便用于钙卫蛋白测定,采用ELISA方法检测;同时进行粪便隐血测验(FOBT),收集医院实验室红细胞沉降率(ESR)、C反应蛋白(CRP)检测结果.结果:IBS组粪便钙卫蛋白中位数为12.21 mg/kg,正常对照组为15.36 mg/kg,两组差异无统计学意义(P＞0.05).大肠癌组粪便钙卫蛋白中位数为159.00mg/kg,慢性炎症组为466.00mg/kg,IBS组和正常对照组分别与大肠癌组、慢性炎症组比较,差异均有统计学意义(P＜0.01),以慢性炎症组最高,大肠癌组居中,IBS组和正常对照组较低.当以粪便钙卫蛋白大于50 mg/kg为界定值时,大肠癌组的阳性率为85%,慢性炎症组阳性率91.7%,IBS组阳性率10.0%,正常对照组阳性率5.0%;粪便钙卫蛋白检测阳性率高于FOBT,ESR和CRP的检测结果.结论:粪便钙卫蛋白在IBS鉴别诊断中优于目前临床常用的FOBT,CRP和ESR检测,简便、经济、无创,可以弥补有创检查痛苦、昂贵、不能随时复查的不足,作为IBS确诊前排除有症状的慢性器质性肠病的筛查指标,具有推广价值.

Fecal calprotectin in differential diagnosis of irritable bowel syndrome

Objectives:To assess the value of fecal calprotectin as a non-invasive screening biomarker in differential diagnosis of irritable bowel syndrome compared with fecal occult blood test (FOBT), erythrocyte sedimentation (ESR) or C reactive protein (CRP). Methods: Subjects were a total of 240 persons, including 60 patients with irritable bowel syndrome, 60 patients with colorectal cancer, 60 patients with chronic inflammation, and 60 healthy controls. 5 g fecal samples were collected within one week of endoscopy or before surgical operation. Fecal calprotectin was measured by an enzyme-linked immunosorbent assay (ELISA) kit in spot stool samples. At the same time, FOBT was measured; the results of ESR and CRP in hospital lab were collected. Results:The median of fecal calprotectin concentrations were 12.21 mg/kg and 15.36 mg/kg in IBS and healthy controls,respectively. There was no statistical significance of calprotectin concentration between patients with IBS and healthy controls (P>0.05). The median of fecal calprotectin concentrations were 159.00 mg/kg and 466.00 mg/kg in colorectal cancer and chronic inflammation respectively. There were statistical significance between patients with chronic inflammation, colorectal cancer, and others (P<0.01). The maximal calprotctin concentration was with chronic inflammation; the medium with colorectal cancer; the minimum with IBS and healthy controls. When the cut-off limit was set as 50 mg/kg of fecal calprotectin, the positive rates of colorectal cancer, chronic inflammation, IBS and healthy controls were 85.0%, 91.7%, 10%, and 5%,respectively. Fecal calprotectin was much superior to FOBT, ESR and CRP. Conclusion: Fecal calprotectin as a non-invasive screening biomarker in the differential diagnosis of IBS and symptomatic chronic large intestinal organic disease was better than FOBT, ESR and CRP. It was simple, inexpensive, repeatable and no-invasive. It can be used as a biomarker in exclusion from related organic diseases before the diagnosis of irritable bowel syndrome.