Clinical significance of determining the level of biliary calprotectin in patients with cholangiocarcinoma or choledocholithiasis

Tingting JI; Bingqing BAI; Yufang CUI; Shaofei WANG; Jianglong HONG; Yang LI; Junjun BAO; Qiao MEI

doi:10.12449/JCH240321

Volume 40 Issue 3

Mar. 2024

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Article Navigation > Journal of Clinical Hepatology > 2024 > 40(3): 568-572

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Clinical significance of determining the level of biliary calprotectin in patients with cholangiocarcinoma or choledocholithiasis

DOI: 10.12449/JCH240321

Department of Gastroenterology，The First Affiliated Hospital of Anhui Medical University，Hefei 230000，China

Research funding:

Youth Project of Natural Science Foundation of Anhui Province (2008085QH415)

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Corresponding author: MEI Qiao， meiqiaomq@aliyun.com （ORCID： 0000-0002-0635-6564）
Received Date: 2023-06-16
Accepted Date: 2023-07-14
Published Date: 2024-03-20

Abstract

Abstract

Objective To investigate the difference in the level of biliary calprotectin between patients with cholangiocarcinoma and those with choledocholithiasis. Methods Clinical data and bile samples were collected from 34 patients with cholangiocarcinoma and 78 patients with choledocholithiasis who were diagnosed and treated with endoscopic retrograde cholangiopancreatography in The First Affiliated Hospital of Anhui Medical University from May 2021 to September 2022. Fluorescence lateral flow immunoassay was used to measure the levels of calprotectin， hemoglobin， and lactoferrin in bile. The Mann-Whitney U test was used for comparison of continuous data between two groups， and the chi-square test was used for comparison of categorical data between two groups； the Spearman correlation test was used for correlation analysis； the DeLong test was used for comparison of the area under the ROC curve （AUC）. Results Compared with the choledocholithiasis group， the cholangiocarcinoma group had significant increases in the levels of calprotectin ［4 795.50 （2 286.79‍ ‍—‍ ‍20 179.73） ng/mL vs 411.16 （67.03‍ ‍—‍ ‍1 991.88） ng/mL， Z=5.572， P<0.001］ and fluoride ［115.70 （109.10‍ — ‍125.50） mmol/L vs 106.60 （98.60‍ ‍—‍ ‍114.40） mmol/L， Z=2.702， P=0.007］. The patients with cholangiocarcinoma were further divided into high cholangiocarcinoma group and low cholangiocarcinoma group， and there was no significant difference between the two groups in the level of calprotectin ［3 867.71 （2 235.66‍ — ‍26 407.40） ng/mL vs 4 795.50 （2 361.15‍ — ‍13 070.53） ng/mL， Z=0.129， P>0.05］. Biliary calprotectin level was correlated with white blood cell count， hemoglobin concentration， and lactoferrin concentration in bile （r=0.316， 0.353， and 0.464， all P<0.05）. The ROC curve analysis showed that biliary calprotectin （with a sensitivity of 79.4% and a specificity of 75.6%）， blood CA19-9 （with a sensitivity of 82.4% and a specificity of 78.2%）， and their combination （with a sensitivity of 88.2% and a specificity of 73.1%） had good sensitivity and specificity in the diagnosis of cholangiocarcinoma. Conclusion There is an increase in the level of biliary calprotectin in patients with cholangiocarcinoma， and therefore， it might become a biomarker for the diagnosis of cholangiocarcinoma.
- Bile Duct Neoplasms,
- Choledocholithiasis,
- Leukocyte L1 Antigen Complex

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据估计，长期暴露于甲氨蝶呤(MTX)导致严重肝纤维化的风险约为5%，这促使人们采取强化监测策略。然而，现有证据来源于回顾性研究，这些研究低估了肝病的风险因素。在Atallah等一项纵向队列研究中，使用两种非侵入性标志物评估了长期MTX治疗对肝纤维化的风险。

在2014年—2021年，笔者从6个英国研究中心前瞻性招募了诊断为≥2年类风湿关节炎或银屑病的成年患者。MTX组包括接受MTX治疗≥6个月的患者，而未暴露组包括从未接受MTX的患者。所有的患者都进行了完整的肝脏分析，包括瞬时弹性成像(TE)和增强肝纤维化(ELF)标志物测量。

共纳入999例患者，平均(60.8±12)岁，女性占62.3%。在976例有效TE值中，149例(15.3%)患者肝硬度≥7.9 kPa。在892例有效ELF值中，262例(29.4%)患者ELF≥9.8。年龄和BMI与肝硬度升高和肝纤维化独立相关。MTX累积剂量和持续时间都与肝硬度升高无关。糖尿病是与肝硬度≥7.9 kPa相关性最显著的危险因素(校正比值比=3.19，95%可信区间：1.95~5.20，P＜0.001)。定期使用非甾体类抗炎药与ELF≥9.8的相关性最强(优势比=1.76，95%可信区间：1.20~2.56，P=0.003)，表明类风湿性关节炎的关节炎症程度可能与作为肝纤维化的非侵入性标志物的ELF相混淆。

笔者认为，先前可能高估了MTX本身导致的肝纤维化风险，有必要考虑修改MTX目前的监测准则。

摘译自ATALLAH E, GROVE JI, CROOKS C, et al. Risk of liver fibrosis associated with long-term methotrexate therapy may be overestimated[J]. J Hepatol, 2023. DOI: 10.1016/j.jhep.2022.12.034. [Oline ahead of print]

(吉林大学第一医院肝胆胰内科纪竹慧辛桂杰报道)

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Clinical significance of determining the level of biliary calprotectin in patients with cholangiocarcinoma or choledocholithiasis

DOI: 10.12449/JCH240321

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Clinical significance of determining the level of biliary calprotectin in patients with cholangiocarcinoma or choledocholithiasis

DOI: 10.12449/JCH240321

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