| Objective: Ileal pouchitis is a common complication of ileal-pouch anal anastomosis(IPAA)in patients with ulcerative colitis(UC),which can affect the function of pouch and lead to pouch failure or malignant change.Therefore,postoperative reexamination should be carried out regularly.Fecal calprotectin(FC),as a non-invasive index reflecting the status of intestinal inflammation,has been confirmed by a large number of studies in the evaluation of UC activity,assessment of remission and prediction of recurrence.However,there are relatively few studies about postoperation of UC.In order to evaluate the application value of FC in the evaluation of pouchitis,correlation between FC and the diagnostic criteria of ileal pouchitis was compared,and so on.Methods: For patients with ulcerative colitis after IPAA,FC concentration,endoscopy,pathology and clinical manifestations of the above patients were collected.According to the PDAI score,patients were divided into two groups: non-pouchitis group and pouchitis group.By collecting the other blood test indexes of the two groups,including C-reactive protein(CRP),ESR and blood routine test,we compared the above clinical indexes of the two groups and the correlation with FC.The significant index statistically performed ROC analysis and combined ROC analysis to get the corresponding cut-off value.Results: 1.33 patients with UC after IPAA were included.According to the calculated PDAI score,the patients were divided into two groups: non-pouchitis group(20 cases)and pouchitis group(13 cases).The scores(including PDAI,m PDAI,OPS,symptom score,endoscopic score and histological score)and FC concentration of pouchitis group were significantly higher than the non-pouchitis group(p<0.001);2.There was a significant correlation between different scoring standards(PDAI vs m PDAI,PDAI vs OPS).The correlation coefficients were 0.9754(0.9492～0.9881)and 0.9683(0.9683～0.9847),respectively.The sensitivity and specificity of diagnosis were both high.3.In addition to the relatively low correlation with symptom scores(r=0.4059,p=0.019),FC had a strong correlation with other scores(p<0.001);4.ROC analysis of FC showed that the cut-off value was 545μg/g,AUC was 0.910,sensitivity was 84.62%,specificity was 85.00%;5.According to the trend curve of FC concentration change,the PDAI score are divided into 0～2 group,3～6 group and ≥7 group.There is statistical difference in FC concentration between 0～2 group and 3～6 group(p=0.008).Compared with ≥7 group,there is statistical significance in FC concentration difference between 3～6 group and ≥7 group(p=0.001).ROC analysis of 0～2 group and 3～6 group was carried out: the cut-off value of FC was 136.9μg/g,AUC was 0.907,sensitivity was 93.33%,specificity was 80.00%.6.There was no significant difference in WBC count and NEU% between the two groups(p>0.05),but there was a significant difference in CRP and ESR between the two groups(p<0.001,p=0.028);7.FC had no significant correlation with WBC and NEU%(p>0.05),but had a moderate correlation with ESR and CRP(r=0.3540,p=0.043;r=0.5212,p=0.002);8.There was no significant correlation between WBC,NEU% with PDAI score(p>0.05).CRP had a moderate correlation with PDAI score(r=0.6297,p<0.001).P value of ESR and PDAI score was in a critical state(p=0.055);9.ROC analysis of CRP and ESR were carried out,and the following results were obtained: CRP’s cut-off value was 0.65mg/dl,AUC was 0.908,sensitivity was 92.31%,specificity was 85.00%;ESR’s cut-off value was 16mm/h,AUC was 0.723,sensitivity was 84.62%,specificity was 65.00%.10.The indicators are combined and analyzed,and the following results are obtained: AUC of combination FC and CRP was 0.954,sensitivity was 100.00%,specificity was 85.00%;AUC of combination FC and ESR was 0.910,sensitivity was 84.62%,specificity was 85.00%;AUC of combination CRP and ESR was 0.908,sensitivity was 92.31%,specificity was 85.00%;AUC of combination of three was 0.954,sensitivity was 100.00%,specificity was 85.00%.Conclusion: 1.Fecal calprotectin is a non-invasive intestinal inflammation evaluation index,can be used for the assessment of ileal pouch inflammation after operation of ulcerative colitis.When FC ≥545μg/g,it can indicate the occurrence of pouchitis,which needs timely diagnosis and treatment.When FC is between 136.9μg/g and 545μg/g,it indicates that patients are in high risk state of pouchitis,further development may lead to the occurrence of pouchitis,and endoscopic reexamination is recommended;2.In the inflammatory indexes of blood test,WBC count and NEU% are two kinds of inflammatory indexes which have poor effect on the evaluation of pouchitis,while C-reactive protein and ESR can be used for the evaluation of pouchitis,and the test efficiency of C-reactive protein is better than ESR;3.The evaluation efficiency of combined fecal calprotectin and C-reactive protein for pouchitis is the greatest,both of them can be detected at the same time in clinical practice to evaluate pouchitis. |
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