Clinical Analysis Of Inflammatory Bowel Disease And Expression Of Calprotectin And Lactoferrin In Inflammatory Bowel Disease

Objective To investigate and analyze the clinical characteristics of inflammatory bowel disease(IBD) . To investigate and discuss the expression of calprotectin and lactoferrin in bowel mucosa and fecal of patients with IBD.Methods The patients with IBD who underwent endoscope examination or surgery from 1997 to 2006 at the first Affiliated Hospital, Anhui Medical University were collected. The patients were registed and followed up according to case questionnaire of IBD. Then 157 patients,including 120 cases of UC and 37 cases of CD, with the complete clinicopathologic features were chosed as the group of disease,and 10 health volunteers as control group.The clinical, endoscopic and histological grading of UC were determined by the colitis activity index(CAI), modified by Baron grading and Truelove-Richards criteria respectively. The disease activity, location and type of UC were determined according to IBD diagnostic and therapeutic criteria from Chinese Society of Gastroenterology. The clinical grading and activity of CD were determined by the Crohn's disease activity index(CDAI). The disease classification of CD was determined according to the Vienna classification. The paraffin-embedded tissue specimens of the groups were made by serial sections. the expression of Cal and Lf in bowel tissues were identified through S-P immunhistochemistry staining. 81 fresh fecal samples were collected from the patients with IBD and the controls,including 52 cases of UC, 19 cases of CD and 10 healthy volunteers. ELISA assay was used to measure the concentrations of Cal and Lf in fecal.Results 1)Clinical Analysis of UC: The ratio of male to female was 1.5/1 in 120 cases of UC. The diagnostic mean age was 40.33±15.41 years old and the mean duration of the disease was 2.76±4.45 years. The cases of mild and moderate severity were the most common(76.3%). In all cases, 54.2% were chronic relapsing, 25% were first onset, and only 1.7% were acute fluminant type. The most of patients revealed pancolitis(40.0%). 27.5% of patients had left-sided colitis. 29.2% of patients had proctitis. Most of the proctitis and left-sided colitis revealed mild and moderate severity. However, most of pancolitis revealed moderate and severe severity. Disease location is not correlated with disease clinical types. The major colonoscopic appearances in active UC were mucosal edema or erythema ,erosion and ulceration . The major histological appearances were cryptitis or crypt abscess , diffuse mucosa inflammation.The clinical severity was significantly correlated with endoscopic and histological grades. 2)Expression of Cal and Lf in UC: Cal and Lf positive expressions were demonstrated in the majority of granulocytes in colon mucosa of patients with active UC, while negative or weakly positive staining in patients with unactive UC and healthy controls were observed. The expression of Cal and Lf were higher in patients with active UC than those with unactive UC and healthy controls(p=0.000). The distribution of Cal and Lf in colon mucosa were significantly correlated with CAI,endoscopic and histological grades(r>0.5 p=0.000). The two parameters between the distribution of Cal and Lf in colon mucosa and the levels of calprotectin and lactoferrin in fecal in UC were correlated well (r=0.588,p=0.000;r=0.519,p=0.000). The levels of Cal and Lf in fecal were significantly correlated with CAI,endoscopic and histological grades (r>0.4,p=0.000). The sensitivity and specificity of fecal Cal and Lf in differentiating the active UC from inactive UC were higher than ESR and CRP. 3)Clinical Analysis of CD: 37 patients with CD included 17 males and 20 females. The ratio of males to females was 0.85/1. Age of diagnosis was ranged from 16 to 66 years old. According to the Vienna classification, 24(64.9%) patients were diagnosed before age of 40 years old(A1) and 13(35.1%) at age of 40 years old or older(A2). There were 11(28.7%) patients with disease involving the terminal ileum only(L1), 11(28.7%) in the colon only (L2), 12(32.4%) in the terminal ileum and colon(L3) and 3(8.2%) in the upper gastrointestinal tract(L4). Disease behaviour was nonstricturing, nonpenetrating(B1) in 12(32.4%) patients, stricturing(B2) in 12(32.4%) patients and penetrating(B3) in 13(35.2%) patients. 70.8% patients diagnosed before the age of 40 years old (A1) were ileocolonic and the terminal ileum disease. 46.2% patients with an age of 40 years old or above(A2) at diagnosis were colonic disease. There was significantly more stricturing disease in the terminal ileum locations than that in colonic locations (54.5% vs 27.3%), however, there was significantly more penetrating disease in pure colonic locations than that in the terminal ileum(36.4% vs 18.2%). Disease activity were determined in all 37 patients according to CDAI. 5(13.5%) patients were unactive. 10(27.0%).patients were mild grade. 15(40.6%)patients were moderate grade and 7(18.9%) patients were severe grade. The majority of ilecolonic locations appeared severe CD activity. 57.1% in cases with severe grade disease were in ileocolic locations. Colonoscopic findings included: mucosal erosion or ulceration, edema or erythema, nodular hyperplasia, preudopolyp and enteric cavity stricture. Granulomas were identifiable in 68.4% of operational biopsy specimens and 46.2% of colonoscopic biopsy specimens. Operational therapy was given in 19(51.4%) cases. 4)Expression of Cal and Lf in CD: Cal and Lf positive expressions were demonstrated in the majority of granulocytes in bowel mucosa of patients with active CD, while negative or weakly positive staining in patients with unactive CD and healthy controls were observed. The expression of Cal and Lf were higher in patients with active CD than those with unactive CD and healthy controls(p=0.000). The distribution of Cal and Lf in bowel mucosa were significantly correlated with CDAI(r=0.764,p=0.000; r=0.842,p=0.000),and the two parameters between the distribution of Cal and Lf in bowel mucosa and the levels of Cal and Lf in fecal in CD were correlated well(r=0.549, p=0.027;r=0.677 p=0.001). The levels of Cal and Lf in fecal were significantly correlated with CDAI(r=0.659,p=0.002;r=0.882,p=0.000). The sensitivity and specificity of fecal Cal and Lf in differentiating the active CD from inactive CD were higher than ESR and CRP. Conclusion 1) The characteristics of UC are as follows:The onset is relatively higher in the middle and old-age group. The course of illness is shorter. The clinical severity of disease are correlated with the extent of colonic involvement, endoscopic and histological grades. 2)The Vennia classification is a simple and easy classification stardard to be performed. It refers to CD patients in china. Surgery incidence is high in our data. 3)We suggest that the expressions of Cal and Lf in the bowel mucosa reflect the degree of disease activity of IBD. Cal and Lf in fecal are mostly derived from the bowel mucosa in IBD, thus the level of Cal and Lf in fecal accurately reflect the degree of disease activity of IBD. This detection method is simple and easy to be performed.