Nakarai Asuka, Kato Jun, Hiraoka Sakiko, Inokuchi Toshihiro, Takei Daisuke, Morito Yuki, Akita Mitsuhiro, Takahashi Sakuma, Hori Keisuke, Harada Keita, Okada Hiroyuki, Yamamoto Kazuhide
Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan.
Intern Med. 2014;53(17):1905-11. doi: 10.2169/internalmedicine.53.2627. Epub 2014 Sep 1.
Although the serum C-reactive protein (CRP) level may, to some extent, predict the disease activity in patients with Crohn's disease (CD), it is not always elevated during periods of disease activity. This study aimed to identify factors predicting the presence of active intestinal lesions in CD patients without an elevated CRP level.
CD patients in whom the presence or absence of active intestinal lesions was evaluated using endoscopic and/or radiologic modalities were divided into two groups based on a negative (<3 mg/L) or positive (≥3 mg/L) CRP level. The correlations between the presence of active intestinal lesions and various clinical variables, including the Crohn's Disease Activity Index (CDAI), leukocyte and platelet counts and hemoglobin, serum albumin and CRP levels, were determined in the CRP-negative patients.
Of the 128 patients examined, 70 had a negative CRP status, approximately half of whom had active intestinal lesions. The multivariate analysis revealed a CDAI of >100 and platelet count of >33×10(4)/μL to be significant predictive factors for the presence of active lesions in the CRP-negative patients [CDAI >100, odds ratio (OR) =5.55; 95% confidence interval (CI), 1.80-18.74, platelet count >33×10(4)/μL, OR =5.94; 95% CI, 1.34-28.87]. The sensitivity of fulfillment of either criterion for the presence of active intestinal lesions was 83%, while the specificity of fulfillment of both criteria was 94%.
A relatively low CDAI and platelet count were identified as predictive markers of the presence of active intestinal lesions in CRP-negative CD patients. These results suggest that symptoms and laboratory data should be evaluated very carefully in such patients.
尽管血清C反应蛋白（CRP）水平在一定程度上可预测克罗恩病（CD）患者的疾病活动度，但在疾病活动期其水平并非总是升高。本研究旨在确定在CRP水平未升高的CD患者中预测存在活动性肠道病变的因素。
使用内镜和/或放射学方法评估是否存在活动性肠道病变的CD患者，根据CRP水平阴性（<3mg/L）或阳性（≥3mg/L）分为两组。在CRP阴性的患者中，确定活动性肠道病变的存在与各种临床变量之间的相关性，包括克罗恩病活动指数（CDAI）、白细胞和血小板计数以及血红蛋白、血清白蛋白和CRP水平。
在检查的128例患者中，70例CRP状态为阴性，其中约一半有活动性肠道病变。多因素分析显示，CDAI>100和血小板计数>33×1⁰⁴/μL是CRP阴性患者存在活动性病变的重要预测因素[CDAI>100，比值比（OR）=5.55；95%置信区间（CI），1.80-18.74，血小板计数>33×1⁰⁴/μL，OR =5.94；95%CI，1.34-28.87]。满足任何一项活动性肠道病变标准的敏感性为83%，而满足两项标准的特异性为94%。
相对较低的CDAI和血小板计数被确定为CRP阴性CD患者存在活动性肠道病变的预测标志物。这些结果表明，对此类患者应非常仔细地评估症状和实验室数据。
