Hoekman Daniël R, Diederen Kay, Koot Bart G P, Tabbers Merit M, Kindermann Angelika, Benninga Marc A
Department of Pediatric Gastroenterology and Nutrition, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
Eur J Pediatr. 2016 Oct;175(10):1335-42. doi: 10.1007/s00431-016-2762-2. Epub 2016 Aug 29.
In adult inflammatory bowel disease (IBD) patients, there is a strong discrepancy between symptoms and biomarkers of inflammation. Data on pediatric IBD patients are conflicting. Therefore, we aimed to investigate the relationship between clinical symptoms and biomarkers of inflammation in pediatric IBD. Patients aged <18 years with previously diagnosed Crohn's disease (CD) or ulcerative colitis (UC) were included. Clinical disease activity was determined using the abbreviated Pediatric CD Activity Index (aPCDAI) or Pediatric UC Activity Index (PUCAI). Biochemical disease activity was assessed using fecal calprotectin (FC) and C-reactive protein (CRP). In total, 127 patients (62 male; median age 14.9 years) were included (82 CD, 45 UC). FC correlated weakly with total aPCDAI score (r s = 0.32; 95 % CI 0.12-0.51; p = 0.003) and total PUCAI score (r s = 0.36; 95 % CI 0.07-0.62; p = 0.015). Only aPCDAI components abdominal examination and perirectal disease and PUCAI component activity level had a significant correlation with levels of FC. CRP correlated weakly with total aPCDAI score (r s = 0.28; 95 % CI 0.05-0.46; p = 0.012) and aPCDAI components abdominal examination and activity level. No significant correlation was observed between CRP and total PUCAI score (r s = 0.01; 95 % CI -0.34-0.29; p = 0.961) or individual PUCAI components.
There is a strong discrepancy between clinical symptoms and biomarkers of inflammation in children with IBD.
• A substantial proportion of asymptomatic pediatric inflammatory bowel disease (IBD) patients have elevated biomarkers of inflammation. • There is a strong discrepancy between symptoms and biomarkers of inflammation in adults with IBD. What is New: • Clinical symptoms are only weakly associated with levels of fecal calprotectin and serum C-reactive protein in children and adolescents with previously diagnosed IBD. • Similarly to adult IBD patients, there is a strong discrepancy between clinical symptoms and biomarkers of inflammation in children with IBD.
在成年炎症性肠病（IBD）患者中，炎症症状与生物标志物之间存在明显差异。关于儿童IBD患者的数据存在矛盾。因此，我们旨在研究儿童IBD临床症状与炎症生物标志物之间的关系。纳入年龄<18岁、先前诊断为克罗恩病（CD）或溃疡性结肠炎（UC）的患者。使用简化的儿童CD活动指数（aPCDAI）或儿童UC活动指数（PUCAI）确定临床疾病活动度。使用粪便钙卫蛋白（FC）和C反应蛋白（CRP）评估生化疾病活动度。总共纳入了127例患者（62例男性；中位年龄14.9岁）（82例CD，45例UC）。FC与aPCDAI总分（rs = 0.32；95%CI 0.12 - 0.51；p = 0.003）和PUCAI总分（rs = 0.36；95%CI 0.07 - 0.62；p = 0.015）弱相关。只有aPCDAI的腹部检查和直肠周围疾病组分以及PUCAI的活动水平组分与FC水平有显著相关性。CRP与aPCDAI总分（rs = 0.28；95%CI 0.05 - 0.46；p = 0.012）以及aPCDAI的腹部检查和活动水平组分弱相关。未观察到CRP与PUCAI总分（rs = 0.01；95%CI -0.34 - 0.29；p = 0.961）或PUCAI各个组分之间存在显著相关性。
IBD患儿的临床症状与炎症生物标志物之间存在明显差异。
• 相当一部分无症状的儿童炎症性肠病（IBD）患者炎症生物标志物升高。• IBD成年患者的症状与炎症生物标志物之间存在明显差异。新发现：• 在先前诊断为IBD的儿童和青少年中，临床症状仅与粪便钙卫蛋白水平和血清C反应蛋白水平弱相关。• 与IBD成年患者类似，IBD患儿的临床症状与炎症生物标志物之间存在明显差异。
