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Background: Ulcerative colitis (UC) is characterized by a chronic intestinal inflammatory disease with relapsing-remitting course, therefore the evaluation of inflammatory activity is essential for defining reasonable therapy and predicting prognosis. Aims: To evaluate the diagnostic value of noninvasive biomarkers in assessing endoscopic activity of UC. Methods: A total of 56 patients with UC from August 2016 to March 2018 at Xiangyang Central Hospital were enrolled, and 25 patients with irritable bowel syndrome (IBS) were served as controls. Fecal calprotectin (FC) level was measured by ELISA. Clinical activity index (CAI) was assessed, and C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were determined. Endoscopic activity was determined by Mayo score. Diagnostic value of noninvasive biomarkers in assessing endoscopic activity of UC was analyzed. Results: FC level was significantly higher in UC patients than in IBS patients (P<0.001). FC, CAI, CRP, ESR in active UC patients were significantly higher than those in remissive UC patients (P<0.001). Mayo score was correlated with FC (r=0.814), CAI (r=0.724), CRP (r=0.610), ESR (r=0.657) (P all <0.001). FC with a cutoff value of 200 μg/g had sensitivity of 92.3% and specificity of 94.1% for detecting endoscopic activity. Conclusions: Compared with CAI, CRP and ESR, FC can more effectively evaluate the endoscopic active inflammation in UC patients.
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Objective@#To explore the feasibility and the value of CT enterography (CTE) in the quantitative evaluation of Crohn's disease (CD).@*Methods@#Retrospectively analyzed 49 patients diagnosed as CD by clinical, enteroscopy, pathology, and imaging from April 2016 to June 2017 in Zhongnan Hospital of Wuhan University. All patients underwent routine enteroscopy and standardized CTE. The interval between the two examinations was less than 2 weeks. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels were measured at intervals. The ESR ranged from 2.0 to 97.0 mm/1 h, with an average of (30.6±26.5) mm/1 h, CRP from 0.3 to 143.3 mg/L, and a median of 27.7 mg/L. CD patients were classified into inactive, mild and moderate-severe according to Crohn's disease simplified endoscopic activity score(SES-CD) after enteroscopy. CTE evaluated the site of lesion, the thickness and enhanced patterns of the most severe lesions of the bowel wall, mural enhanced CT value in the portal vein phase, ΔCT value, stenosis, perienteric inflammation, mesenteric hypervascularity (comb sign), enlarged lymph nodes, abdominal abscesses, fistulas, etc. The Chi-square test was used to compare the differences of enhanced patterns among different groups. ANOVA (Analysis of Variance) was used to compare the differences in bowel wall thickness, plain CT values, mural enhanced CT value in the portal vein phase and ΔCT values among different groups. The correlation between CTE parameters and SES-CD or laboratory data was analyzed by Pearson (normal distribution data) or Spearman (skewed distribution data).@*Results@#SES-CD ranged from 1 to 15, with an average of 5.1±2.6. Among 49 cases, 13 were inactive, 19 were mild, and 17 were moderate-severe. There were 25 cases of intestinal obstruction or stenosis, including 24 cases in the active group and 1 case in the non-active group, and the difference was statistically significant (χ2=13.3, P<0.01). The short diameter of lymph nodes was more than 10 mm in 7 patients, all of them were active patients; 32 cases were mesenteric hypervascularity, manifested as "comb sign" , among them, 28 cases were active and 4 cases were non-active, and the difference was statistically significant (χ2=9.3, P<0.01). Perienteric inflammation was manifested in 30 cases, including 27 cases in the active group and 3 cases in the non-active group, and the difference was statistically significant (χ2=10.8, P<0.01). The enhanced patterns of thickened bowel wall in the non-active was dominated by C and D types, while A and B types was mainly in the active group, and the difference was statistically significant (P<0.05); There were significant differences in bowel wall thickness, mural enhanced CT value in the portal vein phase and ΔCT values between different groups (P<0.05), however, the difference of plain CT values between different groups was not significant (P>0.05). Bowel wall thickness, mural enhanced CT value in the portal vein phase and ΔCT values were all moderately correlated with SES-CD (r were 0.564, 0.585, 0.533, respectively; P all <0.01). Bowel wall thickness was positively correlated with ESR and CRP(r were 0.542, 0.452, respectively; P all <0.01). Mural enhanced CT value in the portal vein phase and ΔCT values were not correlated with ESR or CRP (P>0.05).@*Conclusion@#The bowel wall thickness, mural enhanced CT value in the portal vein phase and the ΔCT value can be used to accurately assess the activity of CD lesions.
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Objective To evaluate the value of fecal calprotectin (FC) and stool lactoferrin (SL) for detecting endoscopic activity and monitoring postoperative recurrence of Crohn disease.Methods Publications in Pubmed,Embase,Science Direct,Springer Link,CBM,Cnki,Wan fang and VIP database before January 1 st 2016 were searched manually.Papers were screened according to inclusion and exclusion criteria.Quality assessment was conducted by QUADAS-2 scale.Meta-Disc 1.4 was used to analyze the heterogeneity of included articles.The pooled sensitivity,specificity,positive likelihood,negative likelihood were calculated respectively and the SROC curve was drawn.Stata 12.0 was used to assess the publication bias.Results A total of 19 papers in English language were included.The pooled sensitivities of FC,SL in detecting endoscopic activity and FC in monitoring postoperative recurrence of Crohn disease were 86％ (95％ CI:84％-88％),72％ (95 ％ CI:66％-79％),80％ (95％ CI:75％-84％),respectively.The specificities were 71％ (95％CI:67％-75％),84％ (95％ CI:74％-91％),65％ (95％ CI:59％-70％),respectively.The areas under the SROC curve were 0.865 6,0.834 6,0.811 0 respectively.The cut-off values of FC in detecting endoscopic activity of Crohn disease were set to ＜ 100 μg/g,100-＜200 μg/g or ≥ 200 μg/g with the area under the SROC curve being 0.898 7,0.788 8,0.888 8,respectively.The cut-off values of FC in monitoring postoperative recurrence of Crohn disease were set to 100-＜ 150 μg/g,150-＜200 μg/g or ≥ 200 μg/g with the areas under the SROC curve being 0.677 4,0.859 4 and 0.759 5,respectively.Conclusion FC and SL have higher diagnostic efficiency than C-reaction protein and are worthy of clinical promotion in detecting endoscopic activity and monitoring postoperative recurrence of Crohn disease.However,endoscopy cannot be replaced.
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PURPOSE: The serum levels of soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) have recently been shown to be correlated highly with disease activity in patients with intestinal Behcet's disease (BD). However, it remains unclear whether sTREM-1 levels reflect endoscopic activity in intestinal BD. This study aimed to evaluate the correlation of sTREM-1 levels with endoscopic activity in intestinal BD. MATERIALS AND METHODS: A total of 84 patients with intestinal BD were enrolled. Endoscopic activity was compared with sTREM-1 levels as well as other laboratory findings, including erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). RESULTS: sTREM-1 levels were significantly increased in intestinal BD patients compared with controls (37.98+/-27.09 pg/mL vs. 16.65+/-7.76 pg/mL, p=0.002), however, there was no difference between endoscopically quiescent and active diseases (43.53+/-24.95 pg/mL vs. 42.22+/-32.68 pg/mL, p=0.819). Moreover, serum sTREM-1 levels did not differ in terms of number, shape, depth, size, margin, or type of ulcer in patients with intestinal BD. However, mean ESR and CRP levels in patients with active disease were significantly higher than those in patients with quiescent disease (p=0.001, p<0.001, respectively). In addition, endoscopic activity scores for intestinal BD were correlated significantly with both CRP levels (gamma=0.329) and ESR (gamma=0.298), but not with sTREM-1 levels (gamma=0.166). CONCLUSION: Unlike CRP levels and ESR, serum sTREM-1 levels were not correlated with endoscopic activity in patients with intestinal BD.