Calprotectin (LH Indholdsside)

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      <HtmlField Name="PageContent"><![CDATA[<h2>Definition</h2>
<ul>
    <li>Calprotectin&nbsp;er et varmestabilt protein, der findes i blod, urin og aff&oslash;ring hos normale personer</li>
    <li>Det findes prim&aelig;rt i neutrofile granulocytter, men findes ogs&aring; i andrecelletyper, fx monocytter og makrofager</li>
    <li>Ved tarminflammation migrerer neutrofile granulocytter gennem tarmv&aelig;ggen ud i tarmlumen, hvilket f&oslash;rer til forh&oslash;jet koncentration af<br>
    calprotectin i f&aelig;ces</li>
    <li>Niveauet af f&aelig;kal calprotectin korrelerer&nbsp;direkte med antallet af neutrofile granulocytter i tarmlumen og&nbsp;er specifikt forh&oslash;jet ved inflammatoriske tarmsygdomme (Morbus Crohn og ulcer&oslash;s colitis)</li>
    <li>F&aelig;kalt Calprotectin korrelerer derfor med sygdomsaktivitet og anvendes til at f&oslash;lge sygdomsaktiviteten (b&aring;de diagnostik og terapimonitorering)</li>
</ul>
<h2>Normalomr&aring;de</h2>
<ul>
    <li>Normalt mindre end 50 mg/kg - b&aring;de hos barn og voksne</li>
    <li>Over 150 mg/kg taler for inflammatorisk tarmsygdom </li>
</ul>
<h2>Aktuelle indikationer</h2>
<ul>
    <li>Differentiere irritabel tarmsyndrom fra inflammatorisk tarmsygdom<a href=" " data-type="journal-reference" data-value="Tibble JA, Sigthorsson G, Bridger S, Fagerhol MK, Bjarnason I, Surrogate markers of intestinal inflammation are predictive of relapse in patients with inflammatory bowel disease. Gastroenterology 2000;119: 15-22" data-value-piped="Tibble JA, Sigthorsson G, Bridger S, Fagerhol MK, Bjarnason I|Surrogate markers of intestinal inflammation are predictive of relapse in patients with inflammatory bowel disease.|Gastroenterology|2000|119|15-22|10889150" data-url="reference-link" data-pubmedid="10889150" title="Tibble JA, Sigthorsson G, Bridger S, Fagerhol MK, Bjarnason I, Surrogate markers of intestinal inflammation are predictive of relapse in patients with inflammatory bowel disease. Gastroenterology 2000;119: 15-22">1</a>
    <ul>
        <li>En metaanalyse viser sensitivitet 93 % og specificitet 96 % hos voksne, 92 % og 76 % hos b&oslash;rn<a href=" " data-type="journal-reference" data-value="Turvill J, High negative predictive value of a normal faecal calprotectin in patients with symptomatic intestinal disease. Frontline Gastroenterol 2012;3: 21-28" data-value-piped="Turvill J|High negative predictive value of a normal faecal calprotectin in patients with symptomatic intestinal disease.|Frontline Gastroenterol|2012|3|21-28|28839626" data-url="reference-link" data-pubmedid="28839626" title="Turvill J, High negative predictive value of a normal faecal calprotectin in patients with symptomatic intestinal disease. Frontline Gastroenterol 2012;3: 21-28">2</a></li>
        <li>Hos voksne betyder det en 67 % reduktion af behov for koloskopi til dette form&aring;l</li>
        <li>I et studie p&aring; patienter henvist fra almen praksis til gastroenterolog var negativ prediktiv v&aelig;rdi for symptomatisk organisk tarmsygdom p&aring; 96 % ved cut-off 50 mg/kg - det betyder at en negativ calprotectin test bekr&aelig;fter funktionel sygdom<a href=" " data-type="journal-reference" data-value="Sipponen T, Savilahti E, Kolho KL, Nuutinen H, Turunen U, Färkkilä M, Crohn's disease activity assessed by fecal calprotectin and lactoferrin: correlation with Crohn's disease activity index and endoscopic findings. Inflamm Bowel Dis 2008;14: 40-6" data-value-piped="Sipponen T, Savilahti E, Kolho KL, Nuutinen H, Turunen U, Färkkilä M|Crohn's disease activity assessed by fecal calprotectin and lactoferrin: correlation with Crohn's disease activity index and endoscopic findings.|Inflamm Bowel Dis|2008|14|40-6|18022866" data-url="reference-link" data-pubmedid="18022866" title="Sipponen T, Savilahti E, Kolho KL, Nuutinen H, Turunen U, Färkkilä M, Crohn's disease activity assessed by fecal calprotectin and lactoferrin: correlation with Crohn's disease activity index and endoscopic findings. Inflamm Bowel Dis 2008;14: 40-6">3</a></li>
    </ul>
    </li>
    <li>Vurdere forl&oslash;b og behandlingseffekt ved <a href="~/link.aspx?_id=7C3C6EF3B3BE4C7AA66DC32DA809FE83&amp;_z=z">Crohn's sygdom</a>&nbsp;og <a href="~/link.aspx?_id=62540B9A858E40508D36FB82EDDEDD59&amp;_z=z">ulcer&oslash;s kolit</a><sup>,</sup><a title="Roseth A, Fagerhol MK, Wasiluk J, et al. A new calprotectin PoC device correlates with ELISA and separates between endoscopic assessed mucosal healing and active ulcerative colitis. Gastroenterology 2007; 132: A175." href=" " data-type="reference" data-value="Roseth A, Fagerhol MK, Wasiluk J, et al. A new calprotectin PoC device correlates with ELISA and separates between endoscopic assessed mucosal healing and active ulcerative colitis. Gastroenterology 2007; 132: A175." data-url="reference-link">4</a></li>
</ul>
<h2>Testegenskaber</h2>
<ul>
    <li>Der anvendes to typer test: Hospitalstest udf&oslash;rt med automatiseret udstyr og test til hjemmemonitorering (udf&oslash;res af patienten selv).&nbsp;</li>
    <li>En metaanalyse viser sensitivitet 89-98 % og specificitet 81-91 % for at skille mellem inflammatorisk tarmsygdom og irritabel tarm syndrom<a title="vonRoon AC, Karamountzos L, Purkayastha S, et al. Diagnostic precision of fecal calprotectin for inflammatory bowel disease and colorectal malignancy. Am J Gastroenterol 2007; 102: 803-13." href=" " data-type="reference" data-value="vonRoon AC, Karamountzos L, Purkayastha S, et al. Diagnostic precision of fecal calprotectin for inflammatory bowel disease and colorectal malignancy. Am J Gastroenterol 2007; 102: 803-13." data-url="reference-link">5</a></li>
    <li>
    <ul>
        <li>Optimalt "cut-off" niveau synes at v&aelig;re 150 mg/kg</li>
    </ul>
    </li>
</ul>
<h2>Pr&oslash;vetagning</h2>
<ul>
    <li>Hospitalsanalyse
    <ul>
        <li>1-5 g af dagens f&oslash;rste f&aelig;ces (svarende til en valn&oslash;d) opsamlet i f&aelig;ces pr&oslash;ver&oslash;r</li>
        <li>Pr&oslash;ven opbevares i k&oslash;leskab, og skal v&aelig;re modtaget p&aring; laboratoriet inden 4 dage</li>
    </ul>
    </li>
    <li>Hjemmem&aring;ling
    <ul>
        <li>10-100 mg f&aelig;ces afh&aelig;ngigt af analysen</li>
        <li> Aff&oslash;ringspr&oslash;ve uden tils&aelig;tning, minimum 10 ml f&aelig;ces&nbsp;</li>
    </ul>
    </li>
</ul>
<h2>Fejlkilder</h2>
<ul>
    <li>C&oslash;liaki giver ikke forh&oslash;jet niveau af calprotectin<a title="Montalto M, Santoro L; Curgliano V, et al. Faecal calprotectin concentrations in untreated celiac patients. Scand J Gastroenterol 2007; 42: 957-61." href=" " data-type="reference" data-value="Montalto M, Santoro L; Curgliano V, et al. Faecal calprotectin concentrations in untreated celiac patients. Scand J Gastroenterol 2007; 42: 957-61." data-url="reference-link">6</a>. Ved mistanke om c&oslash;liaki unders&oslash;g v&aelig;vs transglutaminaser i blod</li>
    <li>Aktiv <a href="~/link.aspx?_id=939AB6BE2EA74C2890648DEA4AF5E6C6&amp;_z=z">reumatoid artri</a>t kan give h&oslash;je v&aelig;rdier </li>
</ul>
<h2>Vurdering af unormalt pr&oslash;vesvar</h2>
<ul>
    <li>&lt; 50: Inflammatorisk tarmsygdom udelukket. Ingen yderligere gastroenterologisk udredning n&oslash;dvendig</li>
    <li>50-150: Tvivlsom forh&oslash;jet. Unders&oslash;gelsen gentages efter 4 uger. Ved gentagne v&aelig;rdier i niveau 50-100 er inflammatorisk tarmsygdom ikke sandsynlig, og yderligere udredning ikke n&oslash;dvendig. Ved gentagne v&aelig;rdier &gt; 100 b&oslash;r patienten henvises til udredning</li>
    <li>
    <p>&gt; 150: Forh&oslash;jet. Inflammatorisk tarmsygdom sandsynlig. En forh&oslash;jet v&aelig;rdi kan ikke alene tolkes som tegn p&aring; inflammatorisk tarmsygdom. Hvis klinikken ikke entydigt tyder p&aring; inflammatorisk tarmsygdom gentages F-calprotectin m&aring;ling f&oslash;r henvisning</p>
    </li>
</ul>
<h2>Opf&oslash;lgning af unormalt pr&oslash;vesvar</h2>
<ul>
    <li>Ved v&aelig;rdier over 150 mg/kg er det grund for at g&oslash;re koloskopi for sikker diagnosticering</li>
    <li>Ved v&aelig;rdier under 50 mg/kg kan man i frav&aelig;r af alarmsymptomer (kr&aelig;ftmistanke, fx v&aelig;gttab, bl&oslash;dning) afst&aring; fra koloskopi</li>
</ul>
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