Mount Sinai Hospital, Zane Cohen Centre for Digestive Diseases, Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto, Canada.
J Crohns Colitis. 2017 May 1;11(5):543-548. doi: 10.1093/ecco-jcc/jjw200.
There is a need for better, less-invasive disease activity indices that provide a representative assessment of endoscopic disease activity. We developed a new clinical score that incorporates the Harvey-Bradshaw index [HBI] with modified patient-reported outcomes [PROp] and physician [clinician]-reported outcomes [PROc] and assessed its ability to measure endosopic disease activity in ileocolonic Crohn's disease [CD].
A cohort of 88 CD patients undergoing colonoscopy was accrued in a prospective fashion. In total, 48 of the subjects were CD cases and 40 had already undergone a post-operative ileocolonic resection [post-op CD]. Each patient underwent multiple, endoscopist-blinded assessments including: HBI score, a PROp question asking for patient perception of disease activity status, a PROc question for clinician perception of disease activity status and C-reactive protein [CRP]. Active endoscopic disease was defined as Simple Endoscopic Score for CD [SES-CD] ≥ 3 for CD subjects and Rutgeerts score > i1 for post-op CD subjects.
Clinical remission as defined by the HBI did not accurately reflect endoscopic remission as defined by the SES-CD (area under the curve [AUC] = 0.54). Combining the HBI with PROp and PROc scores and then further adding CRP significantly improved the correlation with SES-CD [AUC = 0.78 and AUC = 0.88, respectively, p < 0.00001]. In post-op CD, HBI-defined remission also performed poorly against endoscopic remission defined by the Rutgeerts score [AUC = 0.52]. Combining HBI with PROp and the PROc scores and then further adding CRP did not significantly improve the model [AUC = 0.65 and AUC = 0.61, respectively, p = NS].
In CD, the HBI correlates poorly with endoscopic disease activity. However, the HBI-PRO score, which incorporated PROp, PROc, CRP and HBI, significantly improved its ability to predict endoscopic activity in ileocolonic CD without prior surgery.
需要更好、更微创的疾病活动指数来提供对内镜疾病活动的代表性评估。我们开发了一种新的临床评分，该评分将 Harvey-Bradshaw 指数（HBI）与改良的患者报告结局（PROp）和医生（临床医生）报告结局（PROc）相结合，并评估其测量回肠结肠克罗恩病（CD）内镜疾病活动的能力。
前瞻性地招募了 88 例接受结肠镜检查的 CD 患者。共有 48 例为 CD 病例，40 例已接受过回肠结肠切除术（术后 CD）。每位患者接受了多次内镜盲法评估，包括：HBI 评分、询问患者对疾病活动状态的感知的 PROp 问题、临床医生对疾病活动状态的感知的 PROc 问题和 C 反应蛋白（CRP）。活动性内镜疾病定义为 CD 患者的简单内镜 CD 评分（SES-CD）≥3，术后 CD 患者的 Rutgeerts 评分＞i1。
HBI 定义的临床缓解并不能准确反映 SES-CD 定义的内镜缓解（曲线下面积 [AUC] = 0.54）。将 HBI 与 PROp 和 PROc 评分相结合，然后进一步添加 CRP，显著提高了与 SES-CD 的相关性（AUC 分别为 0.78 和 0.88，p＜0.00001）。在术后 CD 中，HBI 定义的缓解与 Rutgeerts 评分定义的内镜缓解也表现不佳（AUC = 0.52）。将 HBI 与 PROp 和 PROc 评分相结合，然后进一步添加 CRP，并未显著改善模型（AUC 分别为 0.65 和 0.61，p = NS）。
在 CD 中，HBI 与内镜疾病活动相关性差。然而，HBI-PRO 评分，纳入了 PROp、PROc、CRP 和 HBI，显著提高了其预测无术前手术的回肠结肠 CD 内镜活动的能力。
