Department of Pharmacology and Therapeutics, University of Manitoba.
Clinical Research Unit, Children's Hospital Research Institute of Manitoba.
J Pediatr Gastroenterol Nutr. 2019 Jul;69(1):82-87. doi: 10.1097/MPG.0000000000002311.
Although anti-Saccharomyces cerevisiae antibodies (ASCAs) could be a useful biomarker in differentiating Crohn disease (CD) from ulcerative colitis (UC), their role as prognostic markers in children with CD has been underinvestigated. This longitudinal prospective observational study aimed to assess the prognostic value of ASCA status among children with CD managed using biologics.
The study population comprised children with inflammatory bowel disease diagnosed with CD from 2012 to 2018. Cox regression model with adjustment for a priori covariates was used to examine the response to anti-tumor necrosis factor (TNF) biological therapy among ASCA-positive patients in comparison to ASCA-negative patients.
There were 273 measurements available from the study cohort comprising children with CD, who were followed up for a median duration of 14 months (interquartile range 5-42). ASCA-positive patients had a higher risk for moderate to severe clinical disease (odds ratio 2.88; 95% confidence interval [CI] 1.2-7.55) and extensive endoscopic distribution (odds ratio 3.30; CI 1.12-9.74) at baseline in comparison to ASCA-negative patients, respectively. In comparison to ASCA immunoglobulin G (IgG)-negative patients, ASCA IgG-positive patients who were treated with biologics had a significantly lower relapse rate (adjusted hazard ratio 0.12; CI 0.02-0.93). Ten (14%) patients had an unstable ASCA value with either ASCA immunoglobulin A or ASCA IgG status changing from positive to negative or vice versa.
ASCA-positive children with CD present with more extensive (endoscopic) and clinically severe disease. ASCA IgG is a useful prognostic marker among children with CD who receive biologics.
抗酿酒酵母抗体（ASCA）可作为鉴别克罗恩病（CD）与溃疡性结肠炎（UC）的有用生物标志物，但在 CD 患儿中作为预后标志物的作用尚未得到充分研究。本纵向前瞻性观察研究旨在评估生物制剂治疗的 CD 患儿中 ASCA 状态的预后价值。
研究人群包括 2012 年至 2018 年诊断为 CD 的炎症性肠病患儿。使用 Cox 回归模型，根据先验协变量进行调整，比较 ASCA 阳性患者与 ASCA 阴性患者对肿瘤坏死因子（TNF）生物治疗的反应。
本研究队列中共有 273 项 CD 患儿的测量数据，中位随访时间为 14 个月（四分位距 5-42）。与 ASCA 阴性患者相比，ASCA 阳性患者在基线时更易发生中重度临床疾病（优势比 2.88；95%置信区间 [CI] 1.2-7.55）和广泛的内镜分布（优势比 3.30；CI 1.12-9.74）。与 ASCA 免疫球蛋白 G（IgG）阴性患者相比，接受生物制剂治疗的 ASCA IgG 阳性患者复发率显著降低（调整后的危险比 0.12；CI 0.02-0.93）。10 名（14%）患者的 ASCA 值不稳定，ASCA IgA 或 ASCA IgG 状态由阳性转为阴性或反之。
CD 患儿中 ASCA 阳性患者表现出更广泛（内镜）和更严重的临床疾病。ASCA IgG 是接受生物制剂治疗的 CD 患儿的有用预后标志物。
