Clinical Significance And Influence Of Granulocyte And Monocyte Apheresis On Fecal Calprotectin In Patients With Ulcerative Colitis

Objective: Ulcerative colitis(UC)is a chronic and non-specific intestinal inflammatory disease with intestinal symptoms and extra-intestinal manifestation.Granulocyte and Monocyte Apheresis(GMA)is a newly developed technique for the treatment of UC of which the main mechanism is to reduce the activated or elevated granulocytes and monocytes.Fecal calprotectin(FC)is a non-invasive index that can reflect the degree of intestinal inflammation.The purpose of this study is to measure fecal calprotectin(FC)and laboratory parameters in patients with UC before and after GMA therapy so as to explore the clinical significance and influence of GMA on fecal calprotectin in patients with UC.Methods: Eighteen patients with active ulcerative colitis treated with granulocyte and monocyte apheresis in the First Affiliated Hospital of Dalian Medical University from June 2019 to January 2020 were included in this study.All the patients underwent GMA therapy of two sessions a week for 5 sessions as one complete course.The clinical data such as clinical activity index(CAI),Mayo endoscopy score(MES),fecal calprotectin(FC),erythrocyte sedimentation rate(ESR),C-reactive protein(CRP),interleukin-8(IL-8),interleukin-6(IL-6),tumor necrosis factor-?(TNF-?),leukocyte count,monocyte count,lymphocyte count,hemoglobin(HB),platelet(PLT)and albumin(ALB),as well as the adverse effects before and after GMA therapy were analyzed.SPSS 22.0 was used for statistical analysis.P<0.05 was considered statistically significant.Result:1.General data: A total of 18 active UC patients were enrolled.Based on Truelove and Witts criteria,1 patient(5%)was mild,5 patients(28%)were moderate,and 12 patients(67%)were severe.Among these patients,13 were males and 5 were females.The ratio of male to female was 2.6:1.The age of the patients ranged from 22 to 65 years old with an average age of 44.44 ± 14.87 years.The average course of the disease was 31.22 ± 43.41 months.According to Montreal classification,7 patients(39%)were E2 and 11 patients(61%)were E3.Among the 18 patients,2 completed one course of GMA(5 sessions),and 16 completed two courses of GMA(10 sessions).2.The results of laboratory parameters: After GMA therapy,FC,CRP,leukocyte count,monocyte count and lymphocyte count were decreased significantly compared with those before treatment(P<0.05).ALB was increased after GMA therapy(P< 0.05).No significant differences were found in other laboratory parameters(P > 0.05).3.Assessment of clinical efficacy: Among the 18 patients,15(83.33%)achieved clinical remission and 8(44.44%)achieved mucosal healing.After GMA therapy,both CAI and MES were decreased significantly compared with those before treatment(P<0.05).The results showed that the GMA treatment was well tolerated with no serious adverse effects.4.The correlation analysis of FC and MES after GMA therapy: There was a significant positive correlation between FC level and MES after GMA therapy(P< 0.05,rs = 0.760).FC level was significantly lower in patients with low MES score(P< 0.05).The FC level was decreased significantly in patients with mucosal healing after GMA therapy(P < 0.05),but the FC level showed no significant difference in the patients without mucosal healing(P > 0.05).Conclusions:1.GMA is an effective and safe therapy for patients with active UC.2.FC can be used as a non-invasive parameter to evaluate the endoscopic findings in patients with UC after GMA therapy.