Mack David R, Langton Christine, Markowitz James, LeLeiko Neal, Griffiths Anne, Bousvaros Athos, Evans Jonathan, Kugathasan Subra, Otley Anthony, Pfefferkorn Mariann, Rosh Joel, Mezoff Adam, Moyer Susan, Oliva-Hemker Maria, Rothbaum Robert, Wyllie Robert, delRosario J Fernando, Keljo David, Lerer Trudy, Hyams Jeffrey
Department of Pediatrics, Children's Hospital of Eastern Ontario, 401 Smyth Rd, Ottawa, Ontario, Canada K1H 8L1.
Pediatrics. 2007 Jun;119(6):1113-9. doi: 10.1542/peds.2006-1865.
The goal was to determine how often common laboratory tests yield normal results at the time of diagnosis for children with inflammatory bowel disease.
Data were obtained from a registry of children with newly diagnosed inflammatory bowel disease who were enrolled prospectively in 18 US/Canadian centers. Laboratory values investigated included hemoglobin level, platelet count, albumin level, and erythrocyte sedimentation rate. Disease severity was categorized by physician global assessment.
A total of 526 children (mean age: 11.6 years; 58% male; 392 with Crohn disease and 134 with ulcerative colitis) were studied. All 4 values were normal for 21% of patients with mild Crohn disease and 54% with mild ulcerative colitis. In contrast, only 3.8% of children with moderate/severe Crohn disease and 4.3% with moderate/severe ulcerative colitis had normal results for all 4 tests. The erythrocyte sedimentation rate was least likely to be normal; overall, 26% of patients with inflammatory bowel disease had a normal erythrocyte sedimentation rate, including 18% with moderate/severe disease. Hemoglobin levels were normal for 32%, platelet counts for 50%, and albumin levels for 60%. There was no clear association between Crohn disease location and either severity or number of normal laboratory values. In contrast, there were direct correlations between ulcerative colitis disease severity and both the extent of bowel inflammation and the number of abnormal laboratory tests.
The presence of normal screening laboratory studies should not dissuade clinicians from considering a diagnosis of inflammatory bowel disease.
本研究旨在确定炎症性肠病患儿在诊断时常规实验室检查结果正常的频率。
数据来自美国/加拿大18个中心前瞻性纳入的新诊断炎症性肠病患儿登记处。研究的实验室指标包括血红蛋白水平、血小板计数、白蛋白水平和红细胞沉降率。疾病严重程度由医生整体评估进行分类。
共研究了526名儿童（平均年龄：11.6岁；58%为男性；392例克罗恩病，134例溃疡性结肠炎）。轻度克罗恩病患者中21%以及轻度溃疡性结肠炎患者中54%的所有4项指标均正常。相比之下，中度/重度克罗恩病患儿中只有3.8%以及中度/重度溃疡性结肠炎患儿中只有4.3%的所有4项检查结果正常。红细胞沉降率最不可能正常；总体而言，26%的炎症性肠病患者红细胞沉降率正常，其中包括18%的中度/重度患者。血红蛋白水平正常的占32%，血小板计数正常的占50%，白蛋白水平正常的占60%。克罗恩病的病变部位与疾病严重程度或正常实验室指标数量之间没有明显关联。相比之下，溃疡性结肠炎的疾病严重程度与肠道炎症范围和异常实验室检查数量之间存在直接相关性。
筛查实验室检查结果正常不应阻止临床医生考虑炎症性肠病的诊断。
