He Chengcheng, Zhang Jie, Chen Zhenyu, Feng Xicheng, Luo Zibin, Wan Tianmo, Li Aimin, Liu Side, Ren Yuexin
Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
Medicine (Baltimore). 2017 Aug;96(33):e7780. doi: 10.1097/MD.0000000000007780.
Relationships between the capsule endoscopy Lewis score (LS) and clinical disease activity indices and C-reactive protein (CRP) are controversial in adult patients with Crohn's disease (CD). Also, data on pediatric patients are relatively less. However, correlation between LS and small bowel transit time (SBTT) remains investigational. The aim of the present study was to explore the correlations between LS and clinical disease activity indices, CRP, SBTT in pediatric, and adult patients with small bowel CD.Retrospective, single-center study on consecutive inpatients with established small bowel CD was conducted. The clinical disease activity index was determined using the abbreviated Pediatric Crohn's Disease Activity Index (aPCDAI) in patients aged <18 years and the Harvey-Bradshaw Simple Index (HBI) in adults. Spearman's rank correlation coefficient was used to assess the correlations of LS with aPCDAI, HBI, CRP, and SBTT, respectively.150 patients were enrolled (30 children and adolescents). In pediatric patients, correlations between LS and aPCDAI, CRP were moderate (r1 = 0.413; r2 = 0.379; P1 = .023; P2 = .044). There was no correlation between LS and SBTT (r = -0.029; P = .88). In adults, weak correlations were found between LS and HBI, SBTT (r1 = 0.213; r2 = 0.237; P1 = .019; P2 = .009). Correlation between LS and CRP was moderate (r = 0.326; P < .001). Strong correlations were found between CRP and HBI, aPCDAI (r1 = 0.522; r2 = 0.650; P < .001). The follow-up patients were all in clinical remission after treatment within 4 months, whereas only a minority reached mucosal healing. HBI, aPCDAI, CRP, and LS in all patients were reduced after treatment, whereas difference in CRP in pediatric patients and difference in LS in adults between baseline and follow-up were not found to be statistically significant. Also, the average SBTT at baseline was not found to be different from that at follow-up in all patients.The role of capsule endoscopy should be emphasized both in pediatric and adult patients with small bowel CD. Furthermore, the small bowel transit time may not be affected by the grade of small intestinal inflammation.
在成年克罗恩病（CD）患者中，胶囊内镜Lewis评分（LS）与临床疾病活动指数及C反应蛋白（CRP）之间的关系存在争议。此外，关于儿科患者的数据相对较少。然而，LS与小肠传输时间（SBTT）之间的相关性仍在研究中。本研究的目的是探讨LS与儿科和成年小肠CD患者的临床疾病活动指数、CRP、SBTT之间的相关性。
对确诊为小肠CD的连续住院患者进行了回顾性单中心研究。对于年龄<18岁的患者，使用简化的儿科克罗恩病活动指数（aPCDAI）来确定临床疾病活动指数；对于成年人，则使用Harvey-Bradshaw简易指数（HBI）。分别采用Spearman等级相关系数评估LS与aPCDAI、HBI、CRP和SBTT的相关性。
共纳入150例患者（30例儿童和青少年）。在儿科患者中，LS与aPCDAI、CRP之间存在中度相关性（r1 = 0.413；r2 = 0.379；P1 = 0.023；P2 = 0.044）。LS与SBTT之间无相关性（r = -0.029；P = 0.88）。在成年人中，LS与HBI、SBTT之间存在弱相关性（r1 = 0.213；r2 = 0.237；P1 = 0.019；P2 = 0.009）。LS与CRP之间存在中度相关性（r = 0.326；P < 0.001）。CRP与HBI、aPCDAI之间存在强相关性（r1 = 0.522；r2 = 0.650；P < 0.001）。所有随访患者在治疗后4个月内均处于临床缓解期，但只有少数患者实现了黏膜愈合。所有患者治疗后HBI、aPCDAI、CRP和LS均降低，但未发现儿科患者CRP的变化及成年人LS在基线和随访之间的差异具有统计学意义。此外，未发现所有患者基线时的平均SBTT与随访时的平均SBTT有差异。
在儿科和成年小肠CD患者中均应强调胶囊内镜的作用。此外，小肠传输时间可能不受小肠炎症程度的影响。
