克罗恩病儿童血生化结果对内镜下疾病活动度的预测分析

Prediction of endoscopic disease activity by analyzing blood biochemical results in children with Crohn's disease

摘要:

目的： 探讨临床基本血生化结果与克罗恩病（Crohn's disease，CD）患儿内镜下表现的关联性，评估主要阳性血生化结果对内镜下评分的预测作用，以指导临床诊疗及随访。方法： 回顾性分析重庆医科大学附属儿童医院2012年1月至2019年4月确诊的41例CD患儿，根据儿童CD疾病活动度指数（pediatric Crohn's disease activity index，PCDAI）进行临床严重度评分分为轻度活动组（轻度组，n=17）和中重度活动组（中重度组，n=24），对2组患儿一般情况、主要临床表现、血生化指标、病变部位、内镜下评分（simplified endoscopic activity score for Crohn's disease，SES-CD）、内镜下典型表现及病理典型表现分析，通过受试者工作特征（receiver operating characteristic，ROC）曲线及相关分析，将主要阳性血生化指标对SES-CD预测效能进行分析。结果： 通过主要临床表现分析，发现中重度组患儿较轻度组具有更高的体质量下降率，差异具有统计学意义（P=0.005）。红细胞计数（red blood cell，RBC）、血红蛋白（hemoglobin，Hb）、白蛋白（albumin，ALB）、血小板计数（platelet，PLT）、红细胞沉降率（erythrocyte sedimentation rate，ESR）及SES-CD在2组中均具有统计学差异（P<0.05），中重度组RBC（3.91±0.15 vs.4.38±0.13，P=0.027）、Hb（91.33±3.67 vs.107.00±3.61，P=0.005）、ALB（33.00±1.27 vs.37.54±1.37，P=0.022）营养指标明显低于轻度组，PLT（492.80±27.10 vs.387.60±31.56，P=0.016）、ESR（78.38±7.39 vs.44.47±5.95，P=0.002）系统炎症指标明显高于轻度组，中重度组SES-CD评分明显高于轻度组（19.50±0.79 vs.11.71±1.09，P<0.001）。通过病变部位分析，中重度组病变在结肠（21/24 vs.9/17，P=0.035）、直肠（23/24 vs.10/17，P=0.011）比例高于轻度组；而2组典型内镜下表现，中重度组在溃疡性表现（24/24 vs.15/17）、增生性表现（17/24 vs.1/17）占比高于轻度组。ROC曲线诊断效能分析发现，PCDAI预测内镜下活动度敏感性、特异性、阳性预测值（positive predictive value，PPV）和阴性预测值（negative predictive value，NPV）均达到100%，PLT预测SES-CD的敏感性和NPV分别为100%和66.67%，而ESR预测SES-CD特异性和PPV分别为76.47%和81.82%。Spearman相关系数分析显示，SES-CD与PCDAI、Hb呈中度相关，与ESR、RBC、ALB呈轻度相关。结论： CD儿童血生化指标中，ESR对SES-CD具有一定相关性和内镜下预测效能，在临床随访及疾病监测中应重点关注。

Abstract:

Objective: To investigate the correlation between clinical basic blood biochemical results and endoscopic findings in children with Crohn's disease (CD), and to evaluate the predictive effect of the main positive blood biochemical results on endoscopic scores to guide clinical diagnosis, treatment and follow-up. Methods: A retrospective analysis was conducted among 41 CD children diagnosed in Children's Hospital of Chongqing Medical University from January 2012 to April 2019. According to the pediatric Crohn's disease activity index (PCDAI) for clinical severity scoring, they were divided into mild activity group (mild group, n=17) and moderate-severe activity group (moderate-severe group, n=24) . The general conditions, major clinical manifestations, blood biochemical indicators, lesion locations, simplified endoscopic activity score for Crohn's disease (SES-CD) of the two groups of children, and typical endoscopic and pathological manifestations were analyzed, and through receiver operating characteristic (ROC) curve and related analysis, the main positive blood biochemical indicators were also analyzed for the predictive efficacy of SES-CD. Results: Through the analysis of the major clinical manifestations, it was found that children in the moderate-severe group had a higher rate of weight loss than children in the mild group, and the difference was statistically significant (P=0.005) . Red blood cell (RBC), hemoglobin (Hb), albumin (ALB), platelet (PLT), erythrocyte sedimentation rate (ESR) and SES-CD were significantly different between the two groups (P<0.05) . In the moderate-severe group, RBC, Hb and ALB nutritional indicators were significantly lower than those in the mild group (3.91±0.15 vs.4.38±0.13, P=0.027; 91.33±3.67 vs.107.00±3.61, P=0.005; 33.00±1.27 vs.37.54±1.37, P=0.022, respectively), PLT and ESR system inflammation index were significantly higher than those in the mild group (492.80±27.10 vs.387.60±31.56, P=0.016; 78.38±7.39 vs.44.47±5.95, P=0.002), and the SES-CD score was significantly higher than that of the mild group (19.50±0.79 vs.11.71±1.09, P<0.001) . According to the analysis of lesion location, the proportion of lesions in the colon (21/24 vs.9/17, P=0.035) and rectum (23/24 vs.10/17, P=0.011) in the moderate-severe group was higher than that in the mild group; while in terms of the typical endoscopic performance of the two groups, the moderate-severe group had higher proportions of ulcerative performance (24/24 vs.15/17) and proliferative performance (17/24 vs.1/17) than the mild group. ROC curve diagnostic efficiency analysis found that the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of PCDAI in predicting endoscopic activity reached up to 100%, the sensitivity and NPV of PLT in predicting SES-CD were 100% and 66.67% respectively, while ESR in predicting SES-CD specificity and PPV were 76.47% and 81.82%, respectively. Spearman correlation coefficient analysis showed that SES-CD had a moderate relationship with PCDAI and Hb, and a mild relationship with ESR, RBC and ALB. Conclusion: ESR in the blood biochemical indexes of CD children have a certain correlation with SES-CD and the predictive efficiency of endoscopy, which should be paid more attention to in clinical follow-up and disease monitoring.