粪便钙卫蛋白联合中性粒细胞/淋巴细胞比值在腺瘤性结肠息肉中的诊断价值

马兰; 李扬; 王霞

doi:10.3969/j.issn.1671-038X.2024.06.13

粪便钙卫蛋白联合中性粒细胞/淋巴细胞比值在腺瘤性结肠息肉中的诊断价值

- 南京市浦口区中医院脾胃科(南京，211800)
基金项目:
南京市浦口区社会事业科技项目(No：S2020-10)

详细信息

通讯作者: 王霞，E-mail：76495305@qq.com

中图分类号: R256.3

收稿日期: 2023-10-08

刊出日期: 2024-06-15

Diagnostic value of fecal calprotectin combined with neutrophil-to-lymphocyte ratio in adenomatous colonic polyps

- Department of Spleen and Stomach, Nanjing Pukou District Hospital of Traditional Chinese Medicine, Nanjing, 211800, China

More Information

Corresponding author: WANG Xia, E-mail: 76495305@qq.com

Received Date: 08 October 2023

Publish Date: 15 June 2024

摘要

摘要: 目的探讨粪便钙卫蛋白(fecal calprotectin，FC)联合中性粒细胞/淋巴细胞比值(neutrophil-to-lymphocyte ratio，NLR)在腺瘤性结肠息肉患者中的诊断价值。方法选择南京市浦口区中医院脾胃科2022年1月—2023年3月诊治的100例腺瘤性结肠息肉患者(腺瘤性息肉组)及100例增生性结肠息肉患者(增生性息肉组)为研究对象，采用单因素及多因素分析影响腺瘤性结肠息肉患者的危险因素，并绘制受试者工作特征(receiver operating characteristic，ROC)曲线，评估FC对腺瘤性结肠息肉的诊断价值。结果与增生性息肉组比较，腺瘤性息肉组患者的FC及NLR水平均显著增高[88.90(69.71，104.33)μg/g vs 56.28(45.83，66.84)μg/g；2.36(1.78，2.73) vs 1.56(1.33，1.73)]，差异有统计学意义(P < 0.001)。二元logistic回归分析发现，FC及NLR均是影响腺瘤性结肠息肉患者的独立危险因素(FC：OR=6.533，95%CI：1.075~1.141，P < 0.001；NLR：OR=1.173，95%CI：1.722~8.105，P=0.001)。ROC曲线分析显示，FC、NLR、FC联合NLR指标对腺瘤性结肠息肉患者均具有一定的诊断价值，以FC联合NLR的诊断效能最佳(AUC=0.902，95%CI：0.862~0.942，P < 0.001)，最佳截断值为0.267，灵敏度为94%，特异度为67%。结论 FC联合NLR对腺瘤性结肠息肉患者具有良好的诊断价值。
- 结肠息肉 /
- 粪便钙卫蛋白 /
- 中性粒细胞/淋巴细胞比值
Abstract: Objective To investigate the diagnostic value of fecal calprotectin(FC) combined with neutrophil-to-lymphocyte ratio(NLR) in adenomatous colonic polyps.Methods One hundred patients with adenomatous colonic polyps admitted to Department of Spleen and Stomach, Nanjing Pukou District Hospital of Traditional Chinese Medicine were enrolled as the adenomatous colonic polyp group, and 100 patients with hyperplastic colonic polyps were enrolled as hyperplastic colonic polyps group. Univariate and multivariate analyses were used to analyze the risk factors of patients with adenomatous colonic polyps. The receiver operating characteristic(ROC) curve was plotted to evaluate the diagnostic efficacy of FC in adenomatous colonic polyps.Results Compared to the hyperplastic colonic polyps group, the FC and NLR were significantly higher in the adenomatous colonic polyp group[88.90(69.71, 104.33)μg/g vs 56.28(45.83, 66.84)μg/g; 2.36(1.78, 2.73) vs 1.56(1.33, 1.73); both P < 0.001]. Binary logistic regression analysis showed that FC and NLR were independent risk factors of the patients with adenomatous colonic polyp[FC: odds ratio(OR)=6.533, 95%CI: 1.075-1.141, P < 0.001; NLR: OR=1.173, 95%CI: 1.722-8.105, P=0.001]. ROC curve analysis showed that FC combined with NLR could be used for clinical diagnosis of patients with adenomatous colonic polyp(AUC=0.902, 95%CI: 0.862-0.942, P < 0.001), best truncation value is 0.267, sensitivity is 94% and specificity is 67%.Conclusion FC combined with NLR is helpful for clinical diagnosis of patients with adenomatous colonic polyps.
- colonic polyps /
- fecal calprotectin /
- neutrophil-to-lymphocyte ratio

HTML全文

图 1 FC联合NLR诊断效能分析的ROC曲线

下载: 全尺寸图片幻灯片

表 1 增生性息肉组与腺瘤性息肉组患者的临床资料、FC及血常规指标的比较 X ± S，例，M(Q₁，Q₃)

指标	增生性息肉组(n=100)	腺瘤性息肉组(n=100)	t/Z/χ²	P
年龄/岁	64.66±10.13	65.93±9.14	-0.931	0.832
性别			0.512	0.474
男	60	55
女	40	45
FC/(μg/g)	56.28(45.83，66.84)	88.90(69.71，104.33)¹⁾	-9.438	< 0.001
WBC/(×10⁹/L)	8.10±1.58	8.14±1.34	-0.189	0.196
Neu/(×10⁹/L)	4.51±0.95	5.07±1.03	-0.395	0.523
NLR	1.56(1.33，1.73)	2.36(1.78，2.73)¹⁾	-4.653	< 0.001
CRP/(g/L)	7.00(5.00，9.00)	7.00(6.00，9.00)	-1.059	0.289
与增生性息肉组比较，¹⁾P < 0.001。

下载: 导出CSV

表 2 二分类logistic回归分析腺瘤性结肠息肉患者的危险因素

指标	β	S.E.	Wald	P	OR	95%CI
NLR	1.318	0.395	11.127	0.001	1.173	1.722~8.105
FC	0.102	0.015	45.238	< 0.001	6.533	1.075~1.141

下载: 导出CSV

表 3 FC联合NLR对腺瘤性结肠息肉患者的诊断效能分析

指标	截断值	AUC	约登指数	P	95%CI	灵敏度/%	特异度/%
FC	65.295 μg/g	0.886	0.590	< 0.001	0.843~0.930	89	70
NLR	2.440	0.690	0.390	< 0.001	0.615~0.766	49	90
FC联合NLR	0.267	0.902	0.610	< 0.001	0.862~0.942	94	67

下载: 导出CSV

参考文献(21)

[1]	Sung H, Ferlay J, Siegel RL, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries[J]. CA Cancer J Clin, 2021, 71(3): 209-249. doi: 10.3322/caac.21660
[2]	Yu L, Li N, Zhang XM. Analysis of 234 cases of colorectal polyps treated by endoscopic mucosal resection[J]. World J Clin Cases, 2020, 8(21): 5180-5187. doi: 10.12998/wjcc.v8.i21.5180
[3]	刘娟, 台卫平, 赵书博, 等. 血清CYFRA21-1、CA72-4、CA50及NSE在结肠息肉及结肠癌鉴别诊断中的价值[J]. 分子诊断与治疗杂志, 2023, 15(1): 90-93, 98. https://www.cnki.com.cn/Article/CJFDTOTAL-YXYQ202301022.htm
[4]	孟曼, 张涛, 苏晓兰, 等. 穴位贴敷改善大肠息肉切除术后腹部不适症状的临床疗效观察[J]. 中国中西医结合消化杂志, 2022, 30(1): 60-64. https://www.zhangqiaokeyan.com/academic-journal-cn_detail_thesis/02012106624706.html
[5]	Di Nardo G, Esposito F, Ziparo C, et al. Faecal calprotectin and ultrasonography as non-invasive screening tools for detecting colorectal polyps in children with sporadic rectal bleeding: a prospective study[J]. Ital J Pediatr, 2020, 46(1): 66. doi: 10.1186/s13052-020-00828-1
[6]	刘玮, 贺照霞, 刘君颖. 205例健康体检人群胃肠镜检查结果统计分析[J]. 中国实用医刊, 2021, 48(23): 1-4. doi: 10.3760/cma.j.cn115689-20210914-03043
[7]	马新力, 王义国. 粪便钙卫蛋白检测在结肠息肉中的应用价值[J]. 中华消化病与影像杂志(电子版), 2019, 9(6): 272-274. doi: 10.3877/cma.j.issn.2095-2015.2019.06.008
[8]	Lee JY, Cevallos SA, Byndloss MX, et al. High-Fat Diet and Antibiotics Cooperatively Impair Mitochondrial Bioenergetics to Trigger Dysbiosis that Exacerbates Pre-inflammatory Bowel Disease[J]. Cell Host Microbe, 2020, 28(2): 273-284. e6. doi: 10.1016/j.chom.2020.06.001
[9]	Fukunaga S, Kuwaki K, Mitsuyama K, et al. Detection of calprotectin in inflammatory bowel disease: Fecal and serum levels and immunohistochemical localization[J]. Int J Mol Med, 2018, 41(1): 107-118.
[10]	彭如洁, 曾庆新, 邱锋. 结肠腺瘤性息肉与膳食纤维及粪便中丁酸含量的相关性研究[J]. 中华临床营养杂志, 2020, 28(3): 140-143. https://www.cnki.com.cn/Article/CJFDTOTAL-LCWZ202308032.htm
[11]	王磊. 同型半胱氨酸、叶酸检测在结肠息肉和结肠癌诊断中的意义[J]. 中国基层医药, 2020, 27(16): 1921-1924.
[12]	魏以召, 常玉英, 谢静. 幽门螺杆菌感染与结肠息肉、结肠癌的相关性[J]. 实用医学杂志, 2019, 35(7): 1120-1123. https://www.cnki.com.cn/Article/CJFDTOTAL-SYYZ201907024.htm
[13]	Katayama Y, Yamada T, Chihara Y, et al. Significance of inflammatory indexes in atezolizumab monotherapy outcomes in previously treated non-small-cell lung cancer patients[J]. Sci Rep, 2020, 10(1): 17495.
[14]	Inamoto S, Kawada K, Okamura R, et al. Prognostic impact of the combination of neutrophil-to-lymphocyte ratio and Glasgow prognostic score in colorectal cancer: a retrospective cohort study[J]. Int J Colorectal Dis, 2019, 34(7): 1303-1315.
[15]	张怡婷, 钱香, 任真, 等. 粪便钙卫蛋白联合血液指标在诊断及评估溃疡性结肠炎活动度中的临床价值[J]. 实用医学杂志, 2021, 37(9): 1199-1202. https://www.cnki.com.cn/Article/CJFDTOTAL-SYYZ202109021.htm
[16]	马亚南, 刘雯, 柴新梅, 等. 粪便钙卫蛋白联合CD64指数及超敏C反应蛋白在儿童细菌性肠炎诊断中的临床价值[J]. 中国中西医结合消化杂志, 2023, 31(9): 691-695. https://www.cnki.com.cn/Article/CJFDTOTAL-ZXPW202309007.htm
[17]	董子瑜, 汪超. 炎症标记物对结直肠癌术后转移患者抗PD-L1免疫治疗效果的预测作用分析[J]. 中国中西医结合消化杂志, 2023, 31(1): 56-60. https://www.zhangqiaokeyan.com/academic-journal-cn_detail_thesis/02012113103371.html
[18]	Caviglia GP, Ribaldone DG, Rosso C, et al. Fecal calprotectin: beyond intestinal organic diseases[J]. Panminerva Med, 2018, 60(1): 29-34.
[19]	Kallel L, Fekih M, Boubaker J. Faecal calprotectin in inflammatory bowel diseases: review[J]. Tunis Med, 2011, 89(5): 425-429.
[20]	Ross FA, Park JH, Mansouri D, et al. The role of faecal calprotectin in the identification of colorectal neoplasia in patients attending for screening colonoscopy[J]. Colorectal Dis, 2022, 24(2): 188-196.
[21]	陈迎珠, 王娟, 徐国宾, 等. 重视粪便血红蛋白免疫学检测在结直肠癌筛查中的应用及质量控制[J]. 临床检验杂志, 2023, 41(1): 1-7. https://www.cnki.com.cn/Article/CJFDTOTAL-LCJY202301003.htm