Gastroenterology Unit, EPIMAD Registry, Rouen University and Hospital, France.
Inflamm Bowel Dis. 2012 Nov;18(11):2072-8. doi: 10.1002/ibd.22898. Epub 2012 Jan 31.
Identification of children with Crohn's disease (CD) at high risk of disabling disease would be invaluable in guiding initial therapy. Our study aimed to identify predictors at diagnosis of a subsequent disabling course in a population-based cohort of patients with pediatric-onset CD.
Among 537 patients with pediatric CD diagnosed at <17 years of age, 309 (57%) with 5-year follow-up were included. Clinical and demographic factors associated with subsequent disabling CD were studied. Three definitions of disabling CD were used: Saint-Antoine and Liège Hospitals' definitions and a new pediatric definition based on the presence at maximal follow-up of: 1) growth delay defined by body mass index (BMI), weight or height lower than -2 SD Z score; and 2) at least one intestinal resection or two anal interventions. Predictors were determined using multivariate analyses and their accuracy using the kappa method considering a relevant value ≥ 0.6.
According to the Saint-Antoine definition, the rate of disabling CD was 77% and predictors were complicated behavior and L1 location. According to the Liège definition, the rate was 37% and predictors included behavior, upper gastrointestinal disease, and extraintestinal manifestations. According to the pediatric definition, the rate of disabling CD was 15%, and predictors included complicated behavior, age <14, and growth delay at diagnosis. Kappa values for each combination of predictors were, respectively, 0.2, 0.3, and 0.2 and were nonrelevant.
Clinical parameters at diagnosis are insufficient to predict a disabling course of pediatric CD. More complex models including serological and genetic biomarkers should be tested.
在指导初始治疗时，识别患有克罗恩病（CD）且有发展为致残性疾病高风险的儿童将具有重要价值。我们的研究旨在识别儿科发病的 CD 患者人群中诊断时预测后续致残性疾病的预测因子。
在<17 岁时被诊断为小儿 CD 的 537 例患者中，有 309 例（57%）具有 5 年随访数据，我们对与随后出现致残性 CD 相关的临床和人口统计学因素进行了研究。使用三种致残性 CD 的定义：圣安东尼医院和列日医院的定义，以及一个基于最大随访时以下情况的新儿科定义：1）生长延迟，定义为体重指数（BMI）、体重或身高低于-2 SD Z 分数；2）至少一次肠切除术或两次肛门干预。使用多变量分析确定预测因子，并使用考虑到相关值≥0.6 的 Kappa 方法评估其准确性。
根据圣安东尼的定义，致残性 CD 的发生率为 77%，预测因子为复杂行为和 L1 位置。根据列日的定义，发生率为 37%，预测因子包括行为、上消化道疾病和肠外表现。根据儿科的定义，致残性 CD 的发生率为 15%，预测因子包括复杂行为、年龄<14 岁和诊断时的生长延迟。每种预测因子组合的 Kappa 值分别为 0.2、0.3 和 0.2，均不相关。
诊断时的临床参数不足以预测儿科 CD 的致残病程。应测试包括血清学和遗传生物标志物在内的更复杂的模型。
