Scarallo Luca, Maniscalco Valerio, Paci Monica, Renzo Sara, Naldini Sara, Barp Jacopo, Tasciotti Laura, Lionetti Paolo
Department of Health Science, University of Florence.
Gastroenterology and Nutrition Unit.
J Pediatr Gastroenterol Nutr. 2020 Jul;71(1):46-51. doi: 10.1097/MPG.0000000000002677.
Acute severe colitis (ASC) is a potentially life-threatening event. Optimal timing for second-line treatment in children is mainly based on the clinical score Pediatric Ulcerative Colitis Activity Index. The aim of our study was to evaluate the potential role of bowel ultrasound scan (BUS) in predicting the need of second-line therapy in ASC.
Patients younger than 18 years admitted to a single tertiary referral center with ASC were included. We retrospectively reviewed medical records collecting clinical and BUS data. Colonic wall thickness (CWT), loss of colonic wall stratification (CWS), presence of hyperechoic lymph nodes, and colonic wall flow evaluated at power Doppler were assessed at BUS performed within the third day of hospitalization.
Sixty-nine ASC episodes from 52 different patients were identified. CWT showed significantly higher values in patients who required second-line therapy (5.14 vs 3.69 mm; P < 0.001). Loss of CWS was present in 17 of 36 (47.2%) of steroid-resistant ASC versus only 1 of 33 of those responding to intravenous corticosteroids (P < 0.001, sensitivity = 47%, specificity = 97%). Using a receiver operating characteristic curve, a cut-off of 3.4 mm was individuated for CWT to predict steroid treatment failure, showing a sensitivity of 92% and a specificity of 52%. The multivariable binary logistic regression analysis identified thickened colonic wall (CWT >3.4 mm) and loss of CWS as independent predictors of steroid resistance.
BUS is a noninvasive, easily accessible, and cost-effective resource that may identify at an early stage first-line therapy failure in pediatric ASC.
急性重症结肠炎（ASC）是一种可能危及生命的疾病。儿童二线治疗的最佳时机主要基于临床评分——儿童溃疡性结肠炎活动指数。本研究的目的是评估肠道超声扫描（BUS）在预测ASC二线治疗需求方面的潜在作用。
纳入一家单一的三级转诊中心收治的18岁以下ASC患者。我们回顾性查阅病历，收集临床和BUS数据。在住院第三天内进行的BUS检查中，评估结肠壁厚度（CWT）、结肠壁分层消失（CWS）、高回声淋巴结的存在情况以及经功率多普勒评估的结肠壁血流情况。
共识别出52例不同患者的69次ASC发作。需要二线治疗的患者CWT值显著更高（5.14对3.69毫米；P<0.001）。36例（47.2%）激素抵抗型ASC中有17例出现CWS消失，而对静脉注射皮质类固醇有反应的33例中仅有1例出现（P<0.001，敏感性=47%，特异性=97%）。使用受试者工作特征曲线，确定CWT预测激素治疗失败的临界值为3.4毫米，敏感性为92%，特异性为52%。多变量二元逻辑回归分析确定结肠壁增厚（CWT>3.4毫米）和CWS消失是激素抵抗的独立预测因素。
BUS是一种无创、易于获取且具有成本效益的资源，可在早期识别儿童ASC的一线治疗失败情况。
