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目的粪便钙卫蛋白(FCal)是一种非侵入性诊断试验,在专科护理中常被用于排除慢性胃肠道症状儿童的炎症性肠病(IBD)。本研究旨在评估基层医疗中FCal对症状儿童IBD的诊断准确性。方法对慢性腹泻和/或复发性腹痛患儿进行前瞻性队列研究:基层医疗中的初诊患儿(基层医疗队列)、转入专科护理的患儿(转诊队列)。检测患儿的基线FCal(指数测试),并将其与IBD的2个参考标准(内镜评估、1年随访)中的1个进行比较。医生对FCal的检测结果不知情,以>50μg/g为阳性结果,计算其在基层医疗队列中的特异度和在转诊队列中的灵敏度。结果基层医疗队列共有患儿114例,最终均未接受IBD诊断,FCal在基层医疗队列中的特异度为0.87〔95%CI(0.80,0.92)〕。转诊队列共有患儿90例,其中17例(19%)接受了IBD诊断,FCal在转诊队列中的灵敏度为0.99〔95%CI(0.81,1.00)〕。结论在基层医疗中,慢性胃肠道症状患儿出现FCal阳性结果不太可能是IBD的指征。FCal阴性结果可能是真阴性,可以安全地排除基层医疗医生考虑转诊至专科护理患儿的IBD可能性。
Purpose Faecal Calprotectin (FCal) is a noninvasive diagnostic test commonly used in specialist care to exclude inflammatory bowel disease (IBD) in children with chronic gastrointestinal symptoms. The aim of this study was to evaluate the diagnostic accuracy of FCal for IBD in symptomatic children in primary care. Methods A prospective cohort study was conducted in children with chronic diarrhea and / or recurrent abdominal pain: newly diagnosed children (primary care cohort) in primary care and children in specialist care (referral cohort). Children were tested for baseline FCal (index test) and compared with 1 of 2 IBD criteria (endoscopy, 1-year follow-up). The doctor did not know the test results of FCal. The positive rate of> 50μg / g was calculated and the specificity of FCal in the primary medical cohort and the sensitivity in the referral cohort were calculated. Results A total of 114 patients with primary medical cohort had no IBD diagnosis. The specificity of FCal was 0.87 (95% CI 0.80, 0.92) in primary cohort. There were 90 infants in the referral cohort, of whom 17 (19%) had IBD and the sensitivity of FCal in the referral cohort was 0.99 (95% CI 0.81, 1.00). Conclusions In primary care, positive FCal findings in children with chronic gastrointestinal symptoms are unlikely to be indications for IBD. FCal-negative results may be true negative and may safely preclude primary care physicians from considering IBD possibilities for referral to specialist care.