粪便CHI3L1对溃疡性结肠炎镜下活动和病情严重程度的预测价值

目的 探讨粪便几丁质酶3样蛋白1（CHI3L1）对溃疡性结肠炎镜下活动和病情严重程度的预测价值。方法 采用病例对照研究，比较2017年3月—2019年5月就诊的183例溃疡性结肠炎患者和健康对照者粪便CHI3L1的差异，分析粪便CHI3L1与溃疡性结肠炎Seo.m临床活动指数（Seo.m CAI）和溃疡性结肠炎镜下严重程度指数（UCEIS）的相关性，绘制受试者工作特征（ROC）曲线分析粪便CHI3L1水平，预测UC镜下活动和病情严重程度的准确性，确定最佳诊断分界点及诊断的敏感性和特异性。结果 溃疡性结肠炎患者粪便CHI3L1水平75.91（17.25，834.72）ng/ml高于健康对照者5.17（3.18，16.45）ng/ml（P <0.05）。溃疡性结肠炎患者临床活动性评估，Seo.m CAI Ⅰ级、Ⅱ级和Ⅲ级3组粪便CHI3L1差异有统计学意义（P <0.05）；镜下活动性评估，UCEIS镜下缓解、轻-中度活动和重度活动3组粪便CHI3L1水平差异有统计学意义（P <0.05）。溃疡性结肠炎患者粪便CHI3L1水平与Seo.m CAI和UCEIS呈正相关（r_s=0.580和0.760，均P <0.05）。粪便CHI3L1水平预测溃疡性结肠炎镜下活动和重度溃疡性结肠炎的ROC曲线下面积分别为0.929（95% Cl：0.877，0.974）和0.908（95% Cl：0.842，0.965）。当粪便CHI3L1>15.28 ng/ml时对诊断溃疡性结肠炎镜下活动具有较高的准确性，敏感性和特异性分别为93.25%（95% Cl：0.895，0.992）和86.39%（95% Cl：0.787，0.914）；当粪便CHI3L1>112.45 ng/ml时对诊断UC重度活动具有较高的准确性，敏感性和特异性分别为87.92%（95% Cl：0.802，0.937）和75.13%（95% Cl：0.674，0.863）。结论 粪便CHI3L1是溃疡性结肠炎镜下活动和重度病情较好的预测指标，在溃疡性结肠炎患者肠道炎症程度评估中具有较高的临床应用价值，是便捷、可靠的非侵入性检查手段之一。

Predictive value of fecal chitinase 3-like 1 in predicting endoscopic activity and severity of ulcerative colitis

Objective To explore the predictive value of fecal chitinase 3-like 1(CHI3L1) in predicting endoscopic activity and severity of ulcerative colitis.Methods A case-control study was conducted to compare the difference of fecal CHI3L1 between 183 ulcerative colitis patients and healthy controls from March 2017 to May 2019, and to analyze the correlation between fecal CHI3L1 and the Seo.m clinical activity index (CAI) of ulcerative colitis and the ulcerative colitis endoscopic index of severity (UCEIS). ROC curve was used to analyze the accuracy of fecal CHI3L1 in predicting endoscopic activity and severity of ulcerative colitis, and to determine the best diagnostic boundary point, sensitivity and specificity of diagnosis.Results The fecal CHI3L1 of ulcerative colitis patients was 75.91 (17.25, 834.72) ng/ml, which was significantly higher than that of healthy controls, was 5.17 (3.18, 16.45) ng/ml) (P < 0.05). There were statistically significant differences in fecal CHI3L1 and the three groups of Seo.m CAI (P < 0.05) and the three groups of UCEIS (P < 0.05). The fecal CHI3L1 level was positively correlated with Seo.m CAI and UCEIS (r_s = 0.580 and 0.760, all P < 0.05). The area under ROC curve of fecal CHI3L1 level predicting endoscopic activity and severity UC was 0.929 (95% Cl: 0.877, 0.974) and 0.908 (95% Cl: 0.842, 0.965). When the fecal CHI3L1 > 15.28 ng/ml, it has highest accuracy in the diagnosis of endoscopic activity, the sensitivity and specificity were 93.25% (95% Cl: 0.895, 0.992) and 86.39% (95% Cl: 0.787, 0.914). When the fecal CHI3L1 >112.45ng/ml, the accuracy of diagnosing severity UC is the highest, the sensitivity and specificity were 87.92% (95% Cl: 0.802, 0.937) and 75.13% (95% Cl: 0.674, 0.863) respectively.Conclusions Fecal CHI3L1 is a better indicator to judge ulcerative colitis endoscopic activity and severe ulcerative colitis, it has high clinical application value in the evaluation of colonic mucositis degree in UC patients, and is one of the convenient and reliable non-invasive examination methods.