“克罗恩病活动指数”在检测克罗恩病术后复发方面并不准确。一项GISC研究。意大利结直肠研究组

"Crohn's disease activity index" is inaccurate to detect the post-operative recurrence in Crohn's disease. A GISC study. Gruppo Italiano per lo Studio del Colon e del Retto.

作者信息

Viscido A, Corrao G, Taddei G, Caprilli R

机构信息

Department of Clinical Sciences, University of Roma La Sapienza, Italy.

出版信息

Ital J Gastroenterol Hepatol. 1999 May;31(4):274-9.

PMID:10425569

Abstract

BACKGROUND

Even though endoscopy is considered to be the gold standard for the detection of post-operative recurrence in Crohn's disease, the Crohn's disease activity index continues to be used for this purpose.

AIM

The aim of this study was, therefore, to assess the accuracy of Crohn's disease activity index to detect post-operative recurrence in Crohn's disease in comparison to endoscopy.

PATIENTS AND METHODS

The study was performed in 110 patients submitted to intestinal resection for Crohn's disease of the terminal ileum. Crohn's disease activity index score was assessed at 6, 12, 24 and 36 months after surgery. At the same intervals colon-ileoscopy was performed in all patients. The Receiver Operating Characteristic analysis was used to assess the accuracy of the Crohn's disease activity index score. Some routine laboratory variables were also analyzed.

RESULTS

Crohn's disease activity index was able to discriminate patients with and without recurrence in 65% of the cases. Considering 150 the standard cut-off value of Crohn's disease activity index, this figure corresponds to a specificity of 89% and a sensitivity of 30%. Out of the laboratory variables erythrocyte sedimentation rate, chloraemia and serum albumin, globally considered in a discriminant function, showed a predictive ability significantly better than Crohn's disease activity index (z = 1.97; two tailed p-value = 0.04). These variables were able to discriminate patients with and without recurrence in 88% of the cases, and at the same value of specificity for the Crohn's disease activity index reached double value of sensitivity (65%). Positive and negative predictive values of laboratory variables (80% and 78%, respectively) were better than the corresponding values of the Crohn's disease activity index score (71% and 56%, respectively).

CONCLUSIONS

These results indicate that the Crohn's disease activity index alone is inadequate for detection of post-operative recurrence in Crohn's disease.

摘要

背景

尽管内镜检查被认为是检测克罗恩病术后复发的金标准，但克罗恩病活动指数仍被用于此目的。

目的

因此，本研究的目的是评估克罗恩病活动指数与内镜检查相比检测克罗恩病术后复发的准确性。

患者和方法

该研究对110例因回肠末端克罗恩病接受肠切除的患者进行。在术后6、12、24和36个月评估克罗恩病活动指数评分。所有患者在相同时间间隔进行结肠镜-回肠镜检查。采用受试者工作特征分析来评估克罗恩病活动指数评分的准确性。还分析了一些常规实验室变量。

结果

克罗恩病活动指数在65%的病例中能够区分有复发和无复发的患者。考虑到克罗恩病活动指数的标准临界值为150，这一数字对应的特异性为89%，敏感性为30%。在判别函数中综合考虑的实验室变量红细胞沉降率、氯血症和血清白蛋白，其预测能力明显优于克罗恩病活动指数（z = 1.97；双侧p值 = 0.04）。这些变量在88%的病例中能够区分有复发和无复发的患者，并且在与克罗恩病活动指数相同的特异性值时，敏感性达到其两倍（65%）。实验室变量的阳性和阴性预测值（分别为80%和78%）优于克罗恩病活动指数评分的相应值（分别为71%和56%）。