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

Huihui Zhang; Jia Liu; Xixi Zhao; Huajian Hu; Yun Yang; Xue Zhan; Zhongyue Li; Xiaoqin Zhou

doi:10.13406/j.cnki.cyxb.003031

您当前的位置：

首页 >

文章列表页 >

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

Clinical research | 更新时间：2022-06-24

- Prediction of endoscopic disease activity by analyzing blood biochemical results in children with Crohn's disease
- Journal of Shanxi Agricultural Sciences Vol. 47, Issue 5, Pages: 583-589(2022)
- 作者机构：
  
  1.重庆医科大学附属儿童医院消化科、儿童发育疾病研究教育部重点实验室、国家儿童健康与疾病临床医学研究中心、儿童发育重大疾病国家国际科技合作基地、儿科学重庆市重点实验室，重庆　400014
  2.四川省成都市妇女儿童中心医院感染消化科，成都　610000
- 作者简介：
- 基金信息：
- DOI：10.13406/j.cnki.cyxb.003031
  CLC： R722.11
- Published：28 May 2022，
  
  Received：04 November 2021，
扫描看全文
Huihui Zhang, Jia Liu, Xixi Zhao, et al. Prediction of endoscopic disease activity by analyzing blood biochemical results in children with Crohn's disease. [J]. Journal of Shanxi Agricultural Sciences 47(5):583-589(2022)
DOI：

Huihui Zhang, Jia Liu, Xixi Zhao, et al. Prediction of endoscopic disease activity by analyzing blood biochemical results in children with Crohn's disease. [J]. Journal of Shanxi Agricultural Sciences 47(5):583-589(2022) DOI： 10.13406/j.cnki.cyxb.003031.

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，

=17）和中重度活动组（中重度组，

=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（

=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（

0.05），中重度组RBC（3.91±0.15 vs.4.38±0.13，

=0.027）、Hb（91.33±3.67 vs.107.00±3.61，

=0.005）、ALB（33.00±1.27 vs.37.54±1.37，

=0.022）营养指标明显低于轻度组，PLT（492.80±27.10 vs.387.60±31.56，

=0.016）、ESR（78.38±7.39 vs.44.47±5.95，

=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，

0.001）。通过病变部位分析，中重度组病变在结肠（21/24 vs.9/17，

=0.035）、直肠（23/24 vs.10/17，

=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

=17) and moderate-severe activity group (moderate-severe group

=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 (

=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 (

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

=0.027; 91.33±3.67 vs.107.00±3.61

=0.005; 33.00±1.27 vs.37.54±1.37

=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

=0.016; 78.38±7.39 vs.44.47±5.95

=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

0.001) . According to the analysis of lesion location

the proportion of lesions in the colon (21/24 vs.9/17

=0.035) and rectum (23/24 vs.10/17

=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.

关键词

儿童克罗恩病内镜血生化预测

Keywords

childrenCrohn's diseaseendoscopyblood biochemistryprediction

references

Benchimol EI, Kaplan GG, Otley AR, et al. Rural and urban residence during early life is associated with risk of inflammatory bowel disease: a population-based inception and birth cohort study[J]. Am J Gastroenterol, 2017, 112(9): 1412-1422.

Sykora J, Pomahacová R, Kreslová M, et al. Current global trends in the incidence of pediatric-onset inflammatory bowel disease[J]. World J Gastroenterol, 2018, 24(25): 2741-2763.

Caio G, Lungaro L, Caputo F, et al. Nutritional treatment in Crohn's disease[J]. Nutrients, 2021, 13(5): 1628.

Thavamani A, Umapathi KK, Khatana J, et al. Burden of psychiatric disorders among pediatric and young adults with inflammatory bowel disease: a population-based analysis[J]. Pediatr Gastroenterol Hepatol Nutr, 2019, 22(6): 527-535.

Tutar E, Bayrak NA, Volkan B, et al. Bowel preparation for colo-noscopy in children: 1 day PEG-3350 with bisacodyl versus 3 day sennosides[J]. Dig Dis, 2019, 37(4): 334-342.

中国医师协会儿科医师分会儿童消化内镜学组. 麻醉状态下儿童择期结肠镜检查肠道准备专家共识[J]. 中国循证儿科杂志, 2021, 16(2): 81-87.

Pediatric Gastroendoscopy Group, Pediatrician Branch, Chinese Medical Association. Expert consensus on bowel preparation for selective colonoscopy in children under anesthesia[J]. Chin J Evid Based Pediatr, 2021, 16(2): 81-87.

中华医学会儿科学分会消化学组, 中华医学会儿科学分会临床营养学组, 陈洁, 等. 儿童炎症性肠病诊断和治疗专家共识[J]. 中华儿科杂志, 2019, 57(7): 501-507.

The Subspecialty Group of Gastroenterology, the Society of Pediatrics, Chinese Medical Association; the Subspecialty Group of Clinical Nutrition, the Society of Pediatrics, Chinese Medical Association, Chen J, et al. Expert consensus on the diagnosis and management of pediatric inflammatory bowel disease[J]. Chin J Pediatr, 2019, 57(7): 501-507.

Koutroumpakis E, Katsanos KH. Implementation of the simple endoscopic activity score in Crohn's disease[J]. Saudi J Gastroenterol, 2016, 22(3): 183-191.

Levine A, Griffiths A, Markowitz J, et al. Pediatric modification of the Montreal classification for inflammatory bowel disease: the Paris classification[J]. Inflamm Bowel Dis, 2011, 17(6): 1314-1321.

何瑶, 陈瑜君, 杨红, 等. 回结肠克罗恩病与肠结核临床及内镜特征比较[J]. 中华消化内镜杂志, 2012, 29(6): 325-328.

He Y, Chen YJ, Yang H, et al. Clinical and colonoseopic characteristics of Crohn disease and intestinal tuberculosis[J]. Chin J Dig Endos, 2012, 29(6): 325-328.

Zhou Y, Huang Y. Inflammatory bowel disease in Chinese children: a retrospective analysis of 49 cases[J]. Exp Ther Med, 2016, 12(5): 3363-3368.

Sawczenko A, Ballinger AB, Savage MO, et al. Clinical features affecting final adult height in patients with pediatric-onset Crohn's disease[J]. Pediatrics, 2006, 118(1): 124-129.

Medina Carbonell FR, Choyudhry Chandan O. Body mass index at presentation of inflammatory bowel disease in children[J]. Pediatr Gastroenterol Hepatol Nutr, 2020, 23(5): 439-446.

Adler J, Dong SM, Eder SJ, et al. Perianal crohn disease in a large multicenter pediatric collaborative[J]. J Pediatr Gastroenterol Nutr, 2017, 64(5): e117-e124.

Gecse KB, Bemelman W, Kamm MA, et al. A global consensus on the classification, diagnosis and multidisciplinary treatment of perianal fistulising Crohn's disease[J]. Gut, 2014, 63(9): 1381-1392.

Singer AA, Gadepalli SK, Eder SJ, et al. Fistulizing Crohn's disease presenting after surgery on a perianal lesion[J]. Pediatrics, 2016, 137(3): e20152878.

李玉佳, 徐樨巍. 17例儿童炎症性肠病临床特征分析[J]. 中国现代医生, 2020, 58(22): 63-66, 70.

LI YJ, Xu XW. Analysis of clinical characteristics of 17 children with inflammatory bowel disease[J]. China Modern Doctor, 2020, 58(22): 63-66, 70.

崔秀秀, 徐萍萍, 徐五琴, 等. 炎症性肠病的临床、内镜和病理特征分析[J]. 胃肠病学, 2017, 22(12): 738-743.

Cui XX, Xu PP, Xu WQ, et al. Analysis of clinical, endoscopic and pathological characteristics of inflammatory bowel disease[J]. Chin J Gastroenterol, 2017, 22(12): 738-743.

Daperno M, D'Haens G, van Assche G, et al. Development and validation of a new, simplified endoscopic activity score for Crohn's disease: the SES-CD[J]. Gastrointest Endosc, 2004, 60(4): 505-512.

Sipponen T, Nuutinen H, Turunen U, et al. Endoscopic evaluation of Crohn's disease activity: comparison of the CDEIS and the SES-CD[J]. Inflamm Bowel Dis, 2010, 16(12): 2131-2136.

Dilillo D, Zuccotti GV, Galli E, et al. Noninvasive testing in the management of children with suspected inflammatory bowel disease[J]. Scand J Gastroenterol, 2019, 54(5): 586-591.

Qin GM, Tu JF, Liu LG, et al. Serum albumin and C-reactive protein/albumin ratio are useful biomarkers of Crohn's disease activity[J]. Med Sci Monit, 2016, 22: 4393-4400.

Daniluk U, Daniluk J, Krasnodebska M, et al. The combination of fecal calprotectin with ESR, CRP and albumin discriminates more accurately children with Crohn's disease[J]. Adv Med Sci, 2019, 64(1): 9-14.

袁柏思, 金鑫鑫, 路又可, 等. 克罗恩病简化内镜评分(SES-CD)与临床和实验室指标相关性的研究[J]. 胃肠病学, 2017, 22(3): 157-162.

Yuan BS, Jin XX, Lu YK, et al. Correlation between simplified endoscopic score for Crohn's disease (SES-CD) and clinical and laboratory markers in patients with crohn's disease[J]. Chin J Gastroenterol, 2017, 22(3): 157-162.

Takaki Y, Mizuochi T, Eda K, et al. Laboratory values in Japanese children with newly diagnosed inflammatory bowel disease[J]. Pediatr Int, 2019, 61(7): 720-725.

查看原文

Views

下载量

CSCD

Alert me when the article has been cited

提交

Tools

Publicity Resources

Prediction of influenza in Chongqing，China，based on the Autoregressive Integrated Moving Average model

Epidemiological and clinical characteristics of human rhinovirus infection in children hospitalized due to lower respiratory tract infections in Yinchuan，China

Predictive value of NLR and PLR for outcome after immunotherapy in advanced urothelial carcinoma

Genetic testing of children with suspected thalassemia in Chongqing area of China: an analysis of 28 287 cases

Related Author

Zhang Huihui

Zou Xiaojiang

Zhao Han

Wang Qiyin

Ye Mengliang

Hei Zhiping

Guo Jianhui

Ji Kai

Related Institution

Department of Gastroenterology, Childrens Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics

School of Public Health，Chongqing Medical University

Chongqing Center for Disease Control and Prevention

Department of Biochemistry and Molecular Biology,School of Basic Medicine,Ningxia Medical University

Department of Clinical Medicine,Ningxia Medical University

⁰