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目的通过比较钙卫蛋白(FC)免疫荧光法与酶联免疫吸附(ELISA)法两种测定方法,探索免疫荧光法测定钙卫蛋白在炎症性肠病(IBD)中的应用价值。方法收集103例患者粪便样本(IBD患者77例,有消化道症状但肠镜检查正常者26例),以ELISA法为对照,计算免疫荧光法的敏感度、特异度、相关系数等指标。收集122例接受结肠镜检查的IBD患者的粪便样本,其中克罗恩病(CD)85例,溃疡性结肠炎(UC)37例,根据CDAI或UCAI评分评估CD或UC的临床活动情况;根据CDEIS、Rutgeert′s评分或Mayo内镜评分评估CD或UC的内镜活动情况。比较缓解期与活动期IBD患者的FC浓度差异,并评价FC对IBD疾病活动情况的预测价值。结果与ELISA法对比,免疫荧光法的敏感度是92.30%,特异度是64.00%,相关系数是0.815(95%CI:0.737~0.871,P<0.05)。使用免疫荧光法时,内镜活动期IBD患者的FC浓度是925.61(408.56~1 634.00)μg/g,高于内镜非活动期的387.78(30.28~679.99)μg/g,差异有统计学意义(P<0.05),当FC的截断值定为300.37μg/g时,其预测IBD内镜活动性病变的敏感性是76.60%,特异性是60.71%。在18例CD术后患者中,72.22%(13/18)出现内镜复发,其免疫荧光法测定的FC浓度值显著高于未复发者,预测CD术后复发的受试者工作曲线下面积是0.923,截断值是407.36μg/g,敏感性为76.92%,特异性为100%。结论免疫荧光法与ELISA法有较好的相关性,敏感性高;FC能有效反映IBD患者的疾病活动情况,对及早发现CD术后复发具有较大的临床意义。
Objective To compare the diagnostic value of calprotectin (FC) immunofluorescence and enzyme-linked immunosorbent assay (ELISA) to explore the value of calprotectin in the diagnosis of inflammatory bowel disease (IBD) by immunofluorescence. Methods Stool samples of 103 patients (77 IBD patients with gastrointestinal symptoms but 26 patients with normal colonoscopy) were collected. The sensitivity, specificity and correlation coefficient of immunofluorescence were calculated by ELISA. Stool samples from 122 IBD patients undergoing colonoscopy were collected, including 85 cases of Crohn’s disease (CD) and 37 of ulcerative colitis. The clinical activity of CD or UC was evaluated according to CDAI or UCAI score. CDEIS, Rutgeert’s score, or Mayo endoscopy score to assess endoscopic activity of the CD or UC. The difference of FC concentration between IBD patients and active IBD patients was compared, and the predictive value of FC for IBD disease activity was evaluated. Results Compared with ELISA, the sensitivity and specificity of immunofluorescence were 92.30% and 64.00%, respectively. The correlation coefficient was 0.815 (95% CI: 0.737-0.871, P <0.05). When using immunofluorescence, the FC concentration of endoscopic active IBD patients was 925.61 (408.56 ~ 1634.00) μg / g, which was higher than that of endoscopic inactive patients (387.78 (30.28 ~ 679.99) μg / g, the difference was statistically significant (P <0.05). When the cutoff value of FC was set at 300.37μg / g, the sensitivity and specificity of FC were 76.60% and 60.71%, respectively. Among the 18 patients with CD, 72.22% (13/18) showed endoscopic recurrence. The FC concentration in the immunofluorescence assay was significantly higher than that in the non-recurrence patients. The area under the working curve of the subjects who relapsed after CD was predicted Is 0.923, cutoff is 407.36 μg / g, sensitivity is 76.92% and specificity is 100%. Conclusion Immunofluorescence method has good correlation with ELISA and high sensitivity. FC can effectively reflect the disease activity of patients with IBD, and has a great clinical significance for early detection of recurrence after CD.