Timmer Antje, Kemptner Daniela, Takses Angela, Klebl Frank, Jöckel Karl-Heinz
Department of Internal Medicine I, University of Regensburg, Regensburg, Germany.
J Clin Epidemiol. 2009 Jul;62(7):771-8. doi: 10.1016/j.jclinepi.2008.07.020. Epub 2008 Dec 24.
Crohn's disease is a highly distressful chronic disorder, characterized by frequent relapses. A symptom-based disease activity index was developed for use in epidemiological research.
One hundred and six consecutive patients presenting to a tertiary referral hospital in Southern Germany in 2004-2005 participated in a questionnaire-based survey. As a reference standard, disease activity was assessed using a clinical index (Crohn's Disease Activity Index [CDAI], based on symptoms reported to physician, laboratory markers, and physician assessed signs). A linear regression equation was calculated based on the survey data on severity of symptoms (dependent variable: CDAI). Survey index scores (S-CDAI) were then calculated using the estimated coefficients for pain, stools, and general well-being in an independent data set.
S-CDAI and CDAI showed moderate agreement (kappa=0.57 for relapse vs. remission). High activity (high S-CDAI) correlated negatively with high quality of life (disease specific: Short Inflammatory Bowel Disease Quality-of-Life Questionnaire; r=-0.67; generic: Short Form 36 physical summary score, r=-0.47). Test-retest reliability and sensitivity for change were good (intraclass correlation coefficient 0.81).
A useful, valid, and reliable disease activity score was developed, which will facilitate meaningful survey research in this chronic disorder.
克罗恩病是一种极具痛苦的慢性疾病，其特点是频繁复发。为用于流行病学研究，开发了一种基于症状的疾病活动指数。
2004年至2005年，连续106名到德国南部一家三级转诊医院就诊的患者参与了一项基于问卷的调查。作为参考标准，使用临床指数（克罗恩病活动指数[CDAI]，基于向医生报告的症状、实验室指标以及医生评估的体征）评估疾病活动度。根据症状严重程度的调查数据（因变量：CDAI）计算线性回归方程。然后在一个独立数据集中，使用疼痛、粪便和总体健康状况的估计系数计算调查指数得分（S-CDAI）。
S-CDAI和CDAI显示出中度一致性（复发与缓解的kappa值为0.57）。高活动度（高S-CDAI）与高生活质量呈负相关（疾病特异性：简短炎症性肠病生活质量问卷；r = -0.67；通用型：简短健康调查36项身体总结得分，r = -0.47）。重测信度和变化敏感性良好（组内相关系数0.81）。
开发了一种有用、有效且可靠的疾病活动评分，这将有助于对这种慢性疾病进行有意义的调查研究。
