摘要
目的比较粪便细菌涂片在不同疾病活动程度的溃疡性结肠炎(ulcerative colitis,UC)患者中的差异,并探讨其作为一种非侵入性检查判断UC活动度方面的应用价值。方法纳入2013年1月至2021年12月就诊于北京大学第三医院消化科的UC患者,同时选取年龄、性别相匹配的非器质性疾病患者作为对照组,收集上述受试者的临床资料、实验室检查结果、粪便直接涂片革兰染色镜检结果。使用改良Mayo评分评估UC患者的疾病活动度。分析粪便细菌涂片的特征及与UC活动程度评分的关系,并绘制ROC曲线。结果共纳入140例UC患者的172次粪便细菌涂片结果,男79例(102次),女61例(70次),年龄(42.0±14.3)岁(18~75岁),和172例对照组的172次粪便细菌涂片结果,男93例,女79例,年龄(44.5±15.8)岁(18~83岁)。UC组的172次检测结果中,疾病中重度活动74次(43.0%),非中重度活动(轻度活动及临床缓解)98次(57.0%),两组间的血常规(WBC、RBC、HGB、HCT、PLT)、ALB、ESR、CRP、便潜血差异有统计学意义(P<0.05)。粪便细菌涂片显示,中重度活动的UC患者粪便G+杆菌与G+球菌之比(阳杆阳球比)显著低于对照组及疾病非中重度活动组(P<0.001)。相关性分析显示,UC患者粪便细菌涂片中的阳杆阳球比与改良Mayo评分呈显著负相关(r=-0.320,P<0.001)。ROC曲线显示,阳杆阳球比对UC中重度活动判断的AUC为0.764,约登指数最大时所对应的截断值为2.5,敏感度55.6%,特异度90.7%,阳性预测率81.1%,阴性预测率73.9%,准确度75.4%。阳杆阳球比联合WBC、HGB、PLT、ALB、ESR、CRP六项实验室检查结果对中重度活动判断的AUC为0.810,敏感度、特异度、阳性预测值、阴性预测值、准确度分别为72.2%、84.0%、76.5%、80.8%、78.5%。结论粪便细菌涂片,特别是阳杆阳球比,作为一种非侵入性检查在判断UC患者的疾病中重度活动有一定的应用价值,联合常用的血液学指标后,准确度有一定提高。
Objective To compare the difference of fecal bacterial smear in patients with ulcerative colitis(UC),and to explore its application value as a non-invasive test in predicting moderate to severe UC activity.[WTHZ]Methods Patients with UC who were admitted to the Department of Gastroenterology,Peking University Third Hospital from Jan.2013 to Dec.2021 were enrolled,and non-organic disease patients with matched age and gender were selected as the control group.Clinical data,laboratory test results and results of fecal bacterial smears were collected.Modified Mayo score was used to evaluate disease activity of UC patients.The characteristics of fecal bacterial smears and their relationship with UC activity score were analyzed,and ROC curves were drawn.[WTHZ]Results A total of 172 fecal bacterial smears of 140 UC patients and 172 fecal bacterial smears of 172 controls were included.Among the 172 test results in the UC group,74 times(43.0%)had moderate to severe disease activity,and 98 times(57.0%)had non-moderate to severe disease activity.The blood routine,ALB,ESR,CRP and fecal occult blood showed statistical differences between the two groups(P<0.05).Fecal bacterial smears showed that the ratio of G+bacilli to G+cocci was significantly lower in UC patients with moderate to severe disease activity than that in the control group and non-moderate to severe disease activity group(P<0.001).Correlation analysis showed that the ratios of G+bacilli to G+cocci of UC patients were significantly negatively correlated with modified Mayo score(r=-0.320,P<0.001).ROC curve showed that the AUC for judging moderate to severe UC activity by the ratio of G+bacilli to G+cocci was 0.764,the cut-off value for calculating the maximum Youden index was 2.5,and the sensitivity,specificity,positive predictive value,negative predictive value and accuracy were 55.6%,90.7%,81.1%,73.9%and 75.4%,respectively.The AUC of the ratio of G+bacilli to G+cocci combined with WBC,HGB,PLT,ALB,ESR and CRP for the judgment of moderate to severe activity was 0.810,and the sensitivity,specificity,positive predictive value,negative predictive value and accuracy were 72.2%,84.0%,76.5%,80.8%and 78.5%,respectively.[WTHZ]Conclusion Fecal bacterial smear,especially the ratio of G+bacilli to G+cocci,has a certain evaluation value for moderate to severe activity of disease in UC patients,and its accuracy has been improved by combining with commonly used hematological indicators.
作者
李高楠
郭怀珠
李军
段丽萍
LI Gaonan;GUO Huaizhu;LI Jun;DUAN Liping(Department of Gastroenterology,Peking University Third Hospital,Beijing 100191,China)
出处
《胃肠病学和肝病学杂志》
CAS
2023年第10期1112-1117,共6页
Chinese Journal of Gastroenterology and Hepatology
基金
国家重点研发计划专项(2021YFA1301304)。
