Department of Pediatrics, King Saud University, Riyadh 11461, Saudi Arabia.
Bioinformatics Program, Boston University, Boston, MA 02215, United States.
World J Gastroenterol. 2018 Oct 21;24(39):4510-4516. doi: 10.3748/wjg.v24.i39.4510.
To investigate the accuracy of fungal dysbiosis in mucosa and stool for predicting the diagnosis of Crohn's disease (CD).
Children were prospectively enrolled in two medical centers: one university hospital and one private gastroenterology clinic in the city of Riyadh, Kingdom of Saudi Arabia. The children with confirmed diagnosis of CD by standard guidelines were considered cases, and the others were considered non-inflammatory bowel disease controls. Mucosal and stool samples were sequenced utilizing Illumina MiSeq chemistry following the manufacturer's protocols, and abundance and diversity of fungal taxa in mucosa and stool were analyzed. Sparse logistic regression was used to predict the diagnosis of CD. The accuracy of the classifier was tested by computing the receiver operating characteristic curves with 5-fold stratified cross-validation under 100 permutations of the training data partition and the mean area under the curve (AUC) was calculated.
All the children were Saudi nationals. There were 15 children with CD and 20 controls. The mean age was 13.9 (range: 6.7-17.8) years for CD children and 13.9 (3.25-18.6) years for controls, and 10/15 (67%) of the CD and 13/20 (65%) of the control subjects were boys. CD locations at diagnosis were ileal (L1) in 4 and colonic (L3) in 11 children, while CD behavior was non-stricturing and non-penetrating (B1) in 12 and stricturing (B2) in 3 children. The mean AUC for the fungal dysbiosis classifier was significantly higher in stools (AUC = 0.85 ± 0.057) than in mucosa (AUC = 0.71 ± 0.067) ( < 0.001). Most fungal species were significantly more depleted in stools than mucosal samples, except for and , which were significantly more abundant. Diversity was significantly more reduced in stools than in mucosa.
We found high AUC of fungal dysbiosis in fecal samples of children with CD, suggesting high accuracy in predicting diagnosis of CD.
探讨黏膜和粪便真菌失调预测克罗恩病（CD）诊断的准确性。
在沙特阿拉伯利雅得市的两家医疗中心（一家大学医院和一家私立胃肠病诊所）前瞻性招募儿童。根据标准指南确诊为 CD 的患儿被视为病例，其余患儿被视为非炎症性肠病对照。根据制造商的方案，利用 Illumina MiSeq 化学对黏膜和粪便样本进行测序，并分析黏膜和粪便中真菌分类群的丰度和多样性。稀疏逻辑回归用于预测 CD 的诊断。通过计算 100 次训练数据分区随机划分的接收器操作特征曲线和平均曲线下面积（AUC）来测试分类器的准确性。
所有患儿均为沙特国民。有 15 例 CD 患儿和 20 例对照。CD 患儿的平均年龄为 13.9 岁（范围：6.7-17.8），对照组为 13.9 岁（3.25-18.6），10/15 例（67%）的 CD 患儿和 13/20 例（65%）的对照组患儿为男孩。诊断时 CD 的部位为回肠（L1）4 例，结肠（L3）11 例，CD 行为为非狭窄非穿透（B1）12 例，狭窄（B2）3 例。粪便真菌失调分类器的平均 AUC 显著高于黏膜（AUC=0.85±0.057 比 0.71±0.067，<0.001）。与黏膜样本相比，粪便中大多数真菌物种明显减少，除外和，它们明显更丰富。多样性在粪便中比在黏膜中显著降低。
我们发现 CD 患儿粪便中真菌失调的 AUC 较高，提示其对 CD 诊断的预测准确性较高。
