摘要目的 评价粪便钙卫蛋白(FC)、粪便乳铁蛋白(SL)检测对评估克罗恩病(CD)内镜下活动性及监测术后复发的价值.方法 计算机检索2016年1月1日前在Pubmed、Embase、ScienceDirect、Springer Link、CBM、中国知网、万方及维普数据库公开发表的文献.按照已定的纳入排除标准筛选文献并提取数据,采用QUADAS-2量表进行严格的文献质量评价,Meta Disc 1.4软件进行异质性分析和定量合成,计算相应值后合并灵敏度、特异度、阳性似然比、阴性似然比,并绘制综合受试者工作特征(SROC)曲线评估其效能,Stata 12.0软件进行发表偏倚检测.结果 共纳入19篇英文文献,Meta分析表明FC、SL评估CD内镜下活动性及FC监测术后复发的合并敏感度分别为86％(95％CI:84％～88％)、72％(95％ CI:66％ ～ 79％)、80％(95％ CI:75％ ～ 84％),合并特异度分别为71％ (95％CI:67％～75％)、84％ (95％CI:74％ ～91％)、65％ (95％ CI:59％～70％),SROC曲线下面积分别为0.865 6、0.834 6、0.811 0.FC评估内镜下疾病活动性研究中,临界值依次为＜100 μg/g、100～ ＜200 μg/g、≥200 μg/g时SROC曲线下面积分别为0.898 7、0.788 8、0.888 8;FC监测术后内镜下复发研究中,临界值依次为100～ ＜150 μg/g、150～ ＜200 μg/g、≥200 μg/g时SROC曲线下面积依次为0.677 4、0.859 4、0.759 5.结论 FC、SL评估CD患者内镜下疾病活动性及监测术后复发效能较C-反应蛋白高,可作为有效辅助指标应用临床,但内镜检查对病情评估的价值不可替代.

abstractsObjective 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.