DIAGNOSTIC VALUE OF LABORATORY AND FECAL BIOMARKERS FOR DETERMINING THE ACTIVITY OF ULCERATIVE COLITIS

Stepanov Yu. M., Psareva I. V., Tatarchuk O. M., Petishko O. P.

CLINICAL AND EXPERIMENTAL MEDICINE

Scentific article

Aim. Determination of the diagnostic value of biomarkers in a non-invasive assessment of intestinal inflammation in patients with ulcerative colitis. Object and methods. We examined 60 patients with ulcerative colitis, in 36 (60.0%) – according to the combined Mayo index, a moderate degree of exacerbation of ulcerative colitis was diagnosed, in 24 (40.0%) – a severe degree of disease activity was diagnosed. The content of α1-antitrypsin (α1-AT) in serum and feces, the level of fecal calprotectin (FC) and myeloperoxidase (MPO), as well as the content of C-reactive protein (CRP) were determined. Results. In patients with ulcerative colitis, the content of fecal α1-AT was increased 4 times (p<0.05), calprotectin (p<0.05) in 26 times and myeloperoxidase (p<0.05) in 35 times. The level of CRP in patients with a severe degree of disease activity increased in 2 times (p<0.05), the content of α1-AT in the feces – in 3 times (p<0.05) and MPO – in 4.5 times (p<0,05). To assess the severe degree of activity of ulcerative colitis, the diagnostic model with feces myeloperoxidase content showed the highest quality (the area under the ROCcurve was 0.874, p<0.0001). The second likely marker was serum CRP level (sensitivity 63.2% and specificity 71.4%). The conclusion. Based on the results of the ROC analysis, it is advisable to determine the level of fecal biomarkers for the diagnosis of ulcerative colitis: area under the ROC-curve for FC is 0.993, area under the ROC-curve for MPO is 0.994. Fecal myeloperoxidase (sensitivity 92.9% and specificity 76.0%) can be used as a non-invasive marker for assessing the degree of activity of ulcerative colitis.

ulcerative colitis, diagnosis, non-invasive markers of inflammation

1. Magro F, Gionchetti P, Eliakim R, Ardizzone S, Armuzzi A, Barreiro-de Acosta M, et al. Third European evidence-based consensus on diagnosis and management of ulcerative colitis. Part 1: definitions, diagnosis, extra-intestinal manifestations, pregnancy, cancer surveillance, surgery, and ileo-anal pouch disorders. J Crohns Colitis. 2017;11(6):649-70. DOI: 10.1093/ecco-jcc/jjx008
2. Ng SC, Shi HY, Hamidi N, Underwood FE, Tang W, Benchimol EI, et al. Worldwide incidence and prevalence of inflammatory bowel disease in the 21st century: a systematic review of population-based studies. Lancet. 2018 Dec 23;390(10114):2769-78. DOI: 10.1016/S0140- 6736(17)32448-0
3. Stepanov YuM, Skyrda IIu, Petishko OP. Hronichni zapalni zahvoryuvannya kishechniku: osoblivosti epidemiologiyi v Ukrayini. Gastroenterologiya. 2017;51(2):97-105. DOI: 10.22141/2308-2097.51.2.2017.101703 [in Ukrainian].
4. Cohen RD, Yu AP, Wu EQ, Xie J, Mulani PM, Chao J. Systematic review: the costs of ulcerative colitis in Western countries. Aliment Pharmacol Ther. 2010;31(7):693‑707. DOI: 10.1111/j.1365-2036.2010.04234.x
5. Nykytyn AV, Vasyleva LV, Matiukhyn AA. Neinvazivnye markery aktivnosti vospalitelnyh zabolevanij kishechnika. Novosti koloproktologii. 2016;6(26):106-11. [in Russian].
6. Mosli MH, Zou G, Garg SK, Feagan SG, MacDonald JK, Chande N, et al. C-reactive protein, fecal calprotectin, and stool lactoferrin for detection of endoscopic activity in symptomatic infl ammatory bowel disease patients: a systematic review and meta-analysis. Am J Gastroenterol. 2015;110(6):802-19. DOI: 10.1038/ajg.2015.120
7. Uchihara M, Kato J, Tsuda S, Yoshida T, Maekita T, Iguchi M, et al. Blood biomarkers reflect integration of severity and extent of endoscopic inflammation in ulcerative colitis. JGH Open. 2017 Nov 1;1(3):98-104. DOI: 10.1002/jgh3.12017
8. Langhorst J, Boone J, Lauche R, Rueffer A, Dobos G. Faecal lactoferrin, calprotectin, PMN-elastase, CRP, and white blood cell count as indicators for mucosal healing and clinical course of disease in patients with mild to moderate ulcerative colitis: post hoc analysis of a prospective clinical trial. Journal of Crohn’s and Colitis. 2016;10(7):786-94. Available from: https://doi.org/10.1093/ecco-jcc/jjw044
9. Cioffi M, Rosa AD, Serao R, Picone I, Vietri MT. Laboratory markers in ulcerative colitis: current insights and future advances. World J Gastrointest Pathophysiol. 2015;6(1):13-22. DOI: 10.4291/wjgp.v6.i1.13
10. Norouzinia M, Chaleshi V, Alizadeh AHM, Zali MR. Biomarkers in inflammatory bowel diseases: insight into diagnosis, prognosis and treatment. Gastroenterol Hepatol Bed Bench. 2017;10(3):155-67.
11.  Abaturov OIe, Stepanova YuIu. Znachennya fekalnogo kalprotektinu pri rotavirusnij infekciyi v ditej rannogo viku. Gastroenterologiya. 2014;4(54):106-9. [in Ukrainian].
12. Langhorst J, Elsenbruch S, Kölzer J, Rueffer A, Michalsen A, Dobos GJ. Non-invasive markers in the assessment of intestinal inflammation in inflammatory bowel diseases: performance of fecal lactoferrin, calprotectin and PMN-elastase, CRP, and clinical indices. Am J Gastroenterol. 2008;103:162-9. DOI: 10.1111/j.1572-0241.2007.01556.x
13. Kolesnykova EV. Alfa-1-antitripsinovaya nedostatochnost: sovremennyj vzglyad na problemu. Suchasna gastroenterologiya. 2008;2:93-8. [in Russian].
14. Peterson CG, Sangfelt P, Wagner M, Hansson T, Lettesjö H, Carlson M. Fecal levels of leukocyte markers reflect disease activity in patients with ulcerative colitis. Scand. J. Clin. Lab. Invest. 2007;67(8):810-20. DOI: 10.1080/00365510701452838
15. Masoodi I, Kochhar R, Dutta U, Vaishnavi C, Prasad KK, Vaiphei K, et al. Fecal lactoferrin, myeloperoxidase and serum C-reactive are effective biomarkers in the assessment of disease activity and severity in patients with idiopathic ulcerative colitis. J Gastroenterol Hepatol. 2009;24(11):1768-74. DOI: 10.1111/j.1440-1746.2009.06048.x
16. Lehmann FS, Burri E, Beglinger C. The role and utility of faecal markers in inflammatory bowel disease. Therapeutic Advances in Gastroenterology. 2015;8(1):23-36. DOI: 10.1177/1756283X14553384
17. Karoui S, Laz S, Serghini M, Bibani N, Boubaker J, Filali A. Correlation of C-reactive protein with clinical and endoscopic activity in patients with ulcerative colitis. Dig Dis Sci. 2011;56(6):1801-5. DOI: 10.1007/s10620-010-1496-7

«Bulletin of problems biology and medicine» Issue 4 Part 1 (153), 2019 year, 158-162 pages, index UDK 616.345-074

10.29254/2077-4214-2019-4-1-153-158-162