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

张慧晖; 刘佳; 赵茜茜; 胡华建; 杨芸; 詹学; 李中跃; 周小勤

doi:10.13406/j.cnki.cyxb.003031

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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

临床研究 | 更新时间：2022-06-24

- 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
- 重庆医科大学学报 2022年47卷第5期页码：583-589
- 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：
  
  张慧晖，Email：bqedkj@163.com，研究方向：儿童炎症性肠病研究。
  周小勤，Email：zhouxiaoqin_20@126.com。
- 基金信息：
  
  国家儿童健康与疾病临床医学研究中心临床医学研究青年资助项目(NCRCCHD-2021-YP-18);重庆市教委科学技术研究资助项目(KJQN201800408)
- DOI：10.13406/j.cnki.cyxb.003031
  中图分类号： R722.11
- 纸质出版日期：2022-05-28，
  
  收稿日期：2021-11-04，
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张慧晖, 刘佳, 赵茜茜, 等. 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[J]. 重庆医科大学学报, 2022,47(5):583-589.

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, 2022,47(5):583-589.
张慧晖, 刘佳, 赵茜茜, 等. 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[J]. 重庆医科大学学报, 2022,47(5):583-589. DOI： 10.13406/j.cnki.cyxb.003031.

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, 2022,47(5):583-589. 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

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