Ülseratif kolit olgularının aktivasyon takibinde fekal kalprotektin değerinin endoskopik aktivite skorlaması ile karşılaştırılması.
Yükleniyor...
Dosyalar
Tarih
2019
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: İnflamatuvar barsak hastalıkları, gastrointestinal sistemin herhangi bir bölgesini
tutabilen, remisyon ve alevlenmelerle seyreden kronik inflamatuvar hastalıklardır. Ülseratif
kolit, Crohn hastalığı ve indetermine kolit bu grupta yer alır. Hastalık aktivasyonunun ortaya
konulmasında hastalık aktivite skorları ve bazı laboratuvar belirteçlerinden faydalanılır. Bu
çalışmada karın ağrısı, ishal/kanlı ishal gibi şikayetlerle hastaneye başvuran ülseratif kolit
hastalarının dışkı numunelerinden ölçülen kalprotektin düzeyini, aynı hastalara alevlenme
şüphesi ile intestinal mukozal enflamasyonu değerlendirmek için yapılan kolonoskopi
esnasında ortaya konulan endoskopik aktivite skorlaması ile karşılaştırmak ve dışkı
kalprotektininin noninvaziv bir belirteç olarak hastalık aktivasyonunu tahmin etmede ve
kolonoskopi ihtiyacını belirlemedeki etkinliğini ortaya koymak amaçlandı.
Yöntem: Çalışmaya Eylül-2016 ve Şubat-2018 tarihleri arasında Konya Necmettin Erbakan
Üniversitesi Meram Tıp Fakültesi Hepatoloji/İBH polikliniğine başvuran ve yapılan
değerlendirme sonucu endoskopi planlanan 19-68 yaş aralığındaki 50 ülseratif kolit hastası
dahil edildi. Fekal kalprotektin ölçümü Konya Necmettin Erbakan Üniversitesi Meram Tıp
Fakültesi Tıbbi Mikrobiyoloji Laboratuvarı’nda gerçekleştirildi. Fekal kalprotektin ölçümü
CalFast (EUROSPİTAL, İtalya) immunokromatografik test kiti ile yapıldı. Test kartları CalFast
READER cihazı ile okunarak sayısal değerler elde edildi. Hastaların hastanemiz
gastroenteroloji bölümünde gerçekleştirilen kolonoskopik incelemeleri neticesinde ortaya
konan Endoskopik Aktivite İndeksi ile fekal kalprotektin ölçümleri arasındaki ilişkinin
belirlenmesi için pearson korelasyon katsayısı hesaplandı. Fekal kalprotektin tanı testinin
tanısal değeri için, endoskopi skoru altın standart olarak alınarak ROC (Receiver Operating
Characteristic) analizi yapıldı. Fekal kalprotektin için 50, 70 ve 100 mg/kg değerleri cut-off
olarak seçildi. Bu değerler için hesaplanan duyarlılık ve özgüllük oranları ile ROC analizi
gerçekleştirildi.
V
Bulgular: Çalışmaya alınan hastaların Endoskopik Aktivite İndeksleri ile dışkı kalprotektin
değerleri karşılaştırıldığında (Fekal kalprotektin>50 ve Endoskopik Aktivite İndeksi≥4 aktif
hastalık kabul edilerek) korele olduğu görüldü (r=0,888661)(p<0,001). Fekal kalprotektinin
ülseratif kolit hastalarında endoskopik aktivite indeksi ile korelasyonunun bulunması, daha
önceki çoğu çalışmanın sonuçları ile uyumludur. Cut-off 50 mg/kg için duyarlılık yüksek,
özgüllük düşük bulundu. 100 mg/kg için ise özgüllük %100 iken Negatif Prediktif Değer(NPV)
düşük olarak gerçekleşti. 50, 70 ve 100 mg/kg cut-off değerlerinden 70 kesme noktasının
ülseratif kolit hastalarında mukozal iyileşme ve aktif hastalık ayrımında daha faydalı
olabileceği değerlendirildi. Farklı cut-off değerleri (50, 70 ve 100 mg/kg) Receiver Operating
Characteristic (ROC) Curve analizi ile değerlendirildiğinde 70 mg/kg cut-off’un ülseratif kolit
hastalığında mukozal aktiviteyi ve hastalık aktivitesini değerlendirmede daha uygun bir
kesme noktası olacağı sonucuna varıldı.
Sonuç: FK, İBH teşhisi için endoskopi gereksinimi olan kişilerin belirlenmesinde , tedavi
etkinliğinin gözlenmesinde ve hastalık alevlenmesini tahmin etmede yararlı, invaziv olmayan
bir biyobelirteçtir. Belli bir hastalığa özgül değildir. Uygun cut-off düzeyleri ile
değerlendirildiği takdirde öneminin daha da belirginleşeceği düşünülmektedir.
Aim: Inflammatory bowel diseases are chronic inflammatory disease with remission and exacerbations that can contribute any part of the gastrointestinal tract. Ulcerative colitis, Crohn’s disease and indeterminate colitis are included in this group. Disease activity scores and some laboratory markers are used to reveal the disease activation. The purpose of this study was to prove calprotectin levels in stool samples taken from patients with ulcerative colitis in admission to hospitals with their complaints as abdominal pain, diarrhea/dysentery and to determine the effectiveness of determining the need for colonoscopy and fecal calprotectin as a noninvasive marker to predict disease activation and the comparison of endoscopic activity scoring during colonoscopy to assess intestinal mucosal inflammation in patients with suspicion of exacerbation. Method: After determining 50 stool samples of patients diagnosed with ulcerative colitis were included in this study between 19-68 age group who were presented to Konya Necmettin Erbakan University Meram Medical Faculty Hepatology / IBD outpatient clinic and were determined as result of the evaluation and included to endoscopy schedule between September-2016 and February-2018. Fecal calprotectin measurement was carried out at Konya Necmettin Erbakan University, Meram Medical Faculty Medical Microbiology Laboratory. Fecal calprotectin was measured by CalFast (EUROSPITAL, Italy) immunochromatographic test kit. Test cards were read by CalFast READER to obtain VII numerical values. Pearson correlation coefficient was calculated to determine the association between the endoscopic activity index and fecal calprotectin measurements as a result of the colonoscopic investigations was performed at the department of gastroenterology of our hospital. Endoscopy score was taken as a gold standard for diagnostic value of fecal calprotectin diagnostic test and Receiver Operating Characteristic Curve analysis was performed. Values of 50, 70 and 100 mg/kg were selected as cut-offs for fecal calprotectin. Receiver Operating Characteristic (ROC) Curve analysis was performed with sensitivity and specificity ratios calculated for these values. Results: Fecal calprotectin levels in ulcerative colitis patients were consistent with the endoscopic activity index. The correlation of fecal calprotectin level with endoscopic activity index in ulcerative colitis patients is consistent with the results of most previous studies. Cutoff was found to have a high specificity of sensitivity to 50 mg/kg. While the specificity was 100% for 100 mg/kg the Negative Predictive Value (NPV) was low. The cut-off points from 50, 70 and 100 mg/kg values, 70 mg/kg cut-off point were evaluated to be more useful in demonstrating mucosal healing or disease activity in ulcerative colitis patients. When different cut-off values were evaluated with 50, 70 and 100 mg/kg ROC curve analysis, it was thought that 70 mg/kg cut-off would be a more suitable cut-off point in evaluating mucosal activity and disease activity in ulcerative colitis disease. Conclusion: Fecal calprotectin is a biomarker that is important for the detection of patients with ambiguous symptoms and for patients with need for endoscopy for the diagnosis of Inflammatory bowel diseases, for the treatment of efficacy, for predicting disease exacerbation, non-invasive but at the same time non-specific, with a significant cut-off.
Aim: Inflammatory bowel diseases are chronic inflammatory disease with remission and exacerbations that can contribute any part of the gastrointestinal tract. Ulcerative colitis, Crohn’s disease and indeterminate colitis are included in this group. Disease activity scores and some laboratory markers are used to reveal the disease activation. The purpose of this study was to prove calprotectin levels in stool samples taken from patients with ulcerative colitis in admission to hospitals with their complaints as abdominal pain, diarrhea/dysentery and to determine the effectiveness of determining the need for colonoscopy and fecal calprotectin as a noninvasive marker to predict disease activation and the comparison of endoscopic activity scoring during colonoscopy to assess intestinal mucosal inflammation in patients with suspicion of exacerbation. Method: After determining 50 stool samples of patients diagnosed with ulcerative colitis were included in this study between 19-68 age group who were presented to Konya Necmettin Erbakan University Meram Medical Faculty Hepatology / IBD outpatient clinic and were determined as result of the evaluation and included to endoscopy schedule between September-2016 and February-2018. Fecal calprotectin measurement was carried out at Konya Necmettin Erbakan University, Meram Medical Faculty Medical Microbiology Laboratory. Fecal calprotectin was measured by CalFast (EUROSPITAL, Italy) immunochromatographic test kit. Test cards were read by CalFast READER to obtain VII numerical values. Pearson correlation coefficient was calculated to determine the association between the endoscopic activity index and fecal calprotectin measurements as a result of the colonoscopic investigations was performed at the department of gastroenterology of our hospital. Endoscopy score was taken as a gold standard for diagnostic value of fecal calprotectin diagnostic test and Receiver Operating Characteristic Curve analysis was performed. Values of 50, 70 and 100 mg/kg were selected as cut-offs for fecal calprotectin. Receiver Operating Characteristic (ROC) Curve analysis was performed with sensitivity and specificity ratios calculated for these values. Results: Fecal calprotectin levels in ulcerative colitis patients were consistent with the endoscopic activity index. The correlation of fecal calprotectin level with endoscopic activity index in ulcerative colitis patients is consistent with the results of most previous studies. Cutoff was found to have a high specificity of sensitivity to 50 mg/kg. While the specificity was 100% for 100 mg/kg the Negative Predictive Value (NPV) was low. The cut-off points from 50, 70 and 100 mg/kg values, 70 mg/kg cut-off point were evaluated to be more useful in demonstrating mucosal healing or disease activity in ulcerative colitis patients. When different cut-off values were evaluated with 50, 70 and 100 mg/kg ROC curve analysis, it was thought that 70 mg/kg cut-off would be a more suitable cut-off point in evaluating mucosal activity and disease activity in ulcerative colitis disease. Conclusion: Fecal calprotectin is a biomarker that is important for the detection of patients with ambiguous symptoms and for patients with need for endoscopy for the diagnosis of Inflammatory bowel diseases, for the treatment of efficacy, for predicting disease exacerbation, non-invasive but at the same time non-specific, with a significant cut-off.
Açıklama
Anahtar Kelimeler
İnflamatuvar barsak hastalıkları, ülseratif kolit, fekal kalprotektin, kolonoskopi.
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Okumuş, Emine Ülkü. Ülseratif kolit olgularının aktivasyon takibinde fekal kalprotektin değerinin endoskopik aktivite skorlaması ile karşılaştırılması (Tıpta Uzmanlık Tezi). Konya: Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi, 2019.
