الفهرس 
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Abstract
Inflammatory bowel diseases (IBDs), which include Crohn’s disease (CD) and ulcerative colitis (UC), are a group of idiopathic, chronic and relapsing inflammatory disorders of the gastrointestinal tract, whose incidence and prevalence has been increasing in the last decade.
UC is continuously affects the colonic mucosa proximal from the rectum and often forms erosions and/or ulcers. CD is characterized by discontinuously affected areas with transmural granulomatous inflammation and/or fistula. CD can affect any region in the digestive tract from the mouth to the anus, but is more likely to involve the small and large intestines (especially the ileocecum) and the perianal region.
Cathelicidin is an endogenous antimicrobial peptide present in the surface of epithelial cells in the colon and stomach. It is one important effector molecule of innate immune defense. It inhibits the growth of various microorganisms, including bacteria, fungi, certain parasites, and viruses by membrane permeabilization. Also, cathelicidin has many other activities related to inflammation and wound healing.. LL-37modulate the activity of immune and inflammatory cells and promote r-epithelialization of human skin wounds.
The aim of this study was to correlate circulating cathelicidin levels with mucosal disease activity in patients with IBD.
This case control cross sectional study was conducted on 45 adult subjects referred to Gastrointestinal Endoscopy and Liver Unit, EL-Haram Hospital.40 of the patients had IBD, the other 40were non IBD patients studied as case control. All subjects were submitted to complete medical history, physical examination, laboratory investigations, colonoscopic examination and cathelicidin serum level.
In our research, we studied a group of 30 IBD patients; 6 of them were diagnosed as CD while 34 patients were diagnosed as UC with a marked predominance than CD, ratio of UC:CD was 6.5:1 this actually coincides with most of the literature from worldwide that says that the incidence of ulcerative colitis is greater than that of Crohn’s.
Inflammatory bowel diseases patients include:
1- Ulcerative colitis patients: they were 34 patients 85% they are subdivided according to disease activity according to (PMS)
group 1a: patients with severe disease activity this group included 2 patients (5.9%) whose PMS= 7-9.
group 1b: patients with moderate disease activity this group included 14 IBD patient (41.2%) whose PMS = 5-6.
group 1c: patients with mild disease activity this group included 18 IBD patients (52.9%) whose PMS= 2-4.
Also UC patients are divided into 3 groups according to Mayo endoscpic subscore (MES) which is used to assess mucosal disease activity of UC patients.
There were 18 patients (52.9%) were mild, 14 patients (41.2%) were moderate and 2 patients (5.9%) were severe mucosal disease activity.
2- Crohn’s disease patients:
They were six patients
group 2a: patient with mild disease activity: This group include 2patients (33.3%) of CD whose HBI = 6.
Group2b: patient with moderate disease activity: this group include 4 patients (66.7%) of CD whose HBI = 8-16
group II control group: This group included 40 apparently healthy volunteers, they were 25 females (62.5%) and 15 males (37.5%), their age ranged from 22 to 51 years with mean (35.55± 9.01).
This study achieved a statistically significant difference of serum LL-37 levels between control with mean34.91 ng/ml and cases group with mean 57.27 ng/ml and significant difference of serum CRP levels between cases with mean (4 mg/l) and control with mean(1.95 mg/l).
Our study showed that Low LL-37 levels indicate moderate and severe disease, and high LL-37 levels indicated Mild activity. So LL-37 is inversely proportion to disease activity.
Also, this study showed that high CRP levels indicated moderate and severe disease, and low CRP levels indicated mild activity. Serum cathelicidin levels were inversely proportional to PMS of UC patients, consistent with its known anti-inflammatory effect. As expected, serum CRP levels were directly proportional to PMS of UC patients and inversely proportion to LL-37.
Our study showed that serum cathelicidins levels were inversely proportional to HBI values of CD patients. However, there was no statistically significant correlation between LL-37 and mucosal disease activity in CD patients (P >0.05). There was highly significant positive correlation between CRP and HBI.
We compared diagnostic accuracies of LL-37 alone, CRP alone, and combined LL-37+CRP for indicating various clinical and mucosal disease activity.
LL-37 is more accurate than CRP as sensitivity of LL-37 is high (82.5%), PPV(86.8) and AUC (84.1%) but sensitivity of CRP was (52.5%), (PPV 87.5%) and AUC was (78. 9%).
A combination of LL-37 and CRP (AUC=93.7%), sensitivity (92.5%) and specificity (87.5). showing that combined CRP+LL-37 more accurate than LL-37 alone or CRP alone. The LL-37 test may be a promising alternative to the CRP test.
Our results showed that there was no statistically significant difference between both studied groups regarding both age and sex distribution.
In this study we found highly significant decrease in Hemoglobin level in cases group compared to control group (p value < 0.001).
Also, there was significant increase in platelets level among cases group compared to control (p value < 0.05). Also, we found that serum albumin was decreased among IBD patients compared to control.