Intestinal clearance and random fecal concentration of alpha-1-antitrypsin in Crohn's disease.
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Intestinal clearance and random fecal concentration of <SUB>α1</SUB>-antitrypsin (<SUB>α1</SUB>AT) in Crohn's disease were measured in order to assess enteric protein loss and to evaluate the clinical value of these parameters. Fecal concentration of <SUB>α1</SUB>AT was measured by radial immunodiffusion (NOR Partigen <SUB>α1</SUB>AT).<BR>In all healthy controls, the fecal concentration of <SUB>α1</SUB>AT was below the detectable limit (<9mg/g dry wt. stool). It was therefore considered that positive <SUB>α1</SUB>AT in feces indicates excessive protein loss into the gastrointestinal tract. Fecal <SUB>α1</SUB>AT was detected in 62% of Crohn's disease patients (82% in the active stage and 34% in remission). Patients with active non-resected Crohn's disease showed higher <SUB>α1</SUB>AT clearance (149±22ml/day, mean±S. E.) than those in remission (90±14), and random fecal <SUB>α1</SUB>AT concentrations were 22.9±1.8mg/g dry wt. stool in the active stage and 20.3±2.2 in remission, although the differences between the values for the active stage and remission were not statistically significant. There was a tendency toward a higher <SUB>α1</SUB>AT clearance in patients without resection compared with patients given previous resection. There were no correlations, or even weak correlations, irrespective of statistical significance, between fecal concentration and intestinal clearance of <SUB>α1</SUB>AT and Harvey's simple index or several other parameters (ESR, CRP, plasma orosomucoid, serum total protein, serum albumin, rapid turnover protein). In patients taking food orally, there was a good correlation between random fecal concentration and intestinal clearance of <SUB>α1</SUB>AT.<BR>The results of this study suggest that measurements of random fecal concentration and intestinal clearance of <SUB>α1</SUB>AT reflect Crohn's disease intestinal activity without the influences of anal lesions or extraintestinal manifestations, and that determination of random fecal <SUB>α1</SUB>AT concentration appears to provide a simple, cheap and valuable method for assessing the degree of enteric protein loss.
- 日本大腸肛門病学会の論文
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