Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan.
Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan.
J Surg Res. 2019 Jun;238:72-78. doi: 10.1016/j.jss.2019.01.022. Epub 2019 Feb 8.
The predictive factors for the development of pouchitis after ileal pouch-anal anastomosis (IPAA) in pediatric-onset ulcerative colitis (UC) have not been well investigated. The present study aimed to determine the predictive factors for the development of pouchitis after IPAA in the pediatric UC population.
The data from 54 patients with pediatric-onset UC who underwent IPAA in Mie University Hospital between 2000 and 2017 were retrospectively reviewed. A modified pouchitis disease activity index of ≥5 was defined as pouchitis. Potential preoperative, intraoperative, and postoperative predictors for pouchitis including various demographic and clinical variables were analyzed using Cox regression analysis, Students' t-tests, Mann-Whitney U tests, and Kaplan-Meier curves. The optimal cutoff value for continuous variables was determined using the receiver operating characteristic curve analysis.
Pouchitis was identified in 17 (31.5%) patients within 5 y of follow-up. In multivariable analysis, the independent predictors for pouchitis were preoperative cumulative steroid dose of >10,000 mg (P = 0.0056) and >65% neutrophils just before IPAA (P = 0.032). Multivariate analysis revealed that the independent predictors of pouchitis were a total steroid dose of >10,000 mg (P = 0.0002) and a neutrophil percentage of >65% (P = 0.0078). No patient for whom both of these independent predictors were negative developed pouchitis, whereas >40% of patients who had one or both predictors developed pouchitis.
In pediatric patients with UC, the predictive factors for pouchitis development are a greater cumulative total dose of steroids and a greater percentage of neutrophils before IPAA.
回肠贮袋肛管吻合术（IPAA）后发生 pouchitis 的预测因素在儿科发病的溃疡性结肠炎（UC）患者中尚未得到很好的研究。本研究旨在确定儿科 UC 患者行 IPAA 后发生 pouchitis 的预测因素。
回顾性分析 2000 年至 2017 年期间在 Mie 大学医院接受 IPAA 的 54 例儿科发病 UC 患者的数据。将改良 pouchitis 疾病活动指数（≥5）定义为 pouchitis。使用 Cox 回归分析、学生 t 检验、Mann-Whitney U 检验和 Kaplan-Meier 曲线分析潜在的术前、术中、术后预测因素，包括各种人口统计学和临床变量。使用受试者工作特征曲线分析确定连续变量的最佳截断值。
在随访的 5 年内，17 例（31.5%）患者出现 pouchitis。多变量分析中， pouchitis 的独立预测因素是术前累积类固醇剂量>10000mg（P=0.0056）和 IPAA 前 65%以上中性粒细胞（P=0.032）。多变量分析显示， pouchitis 的独立预测因素是总类固醇剂量>10000mg（P=0.0002）和中性粒细胞百分比>65%（P=0.0078）。没有同时具有这两个独立预测因素的患者发生 pouchitis，而>40%的患者存在一个或两个预测因素发生 pouchitis。
在儿科 UC 患者中，IPAA 前类固醇累积总剂量和中性粒细胞百分比是 pouchitis 发展的预测因素。
