诊断延迟与儿科克罗恩病的复杂疾病和生长障碍有关。
Diagnostic Delay Is Associated With Complicated Disease and Growth Impairment in Paediatric Crohn's Disease.
机构信息
SickKids Hospital, University of Toronto, Toronto, ON, Canada.
Children's Hospital of Eastern Ontario [CHEO], Inflammatory Bowel Disease Centre, Ottawa, ON, Canada.
出版信息
J Crohns Colitis. 2021 Mar 5;15(3):419-431. doi: 10.1093/ecco-jcc/jjaa197.
BACKGROUND
Paediatric data on the association between diagnostic delay and inflammatory bowel disease [IBD] complications are lacking. We aimed to determine the effect of diagnostic delay on stricturing/fistulising complications, surgery, and growth impairment in a large paediatric cohort, and to identify predictors of diagnostic delay.
METHODS
We conducted a national, prospective, multicentre IBD inception cohort study including 1399 children. Diagnostic delay was defined as time from symptom onset to diagnosis >75th percentile. Multivariable proportional hazards [PH] regression was used to examine the association between diagnostic delay and stricturing/fistulising complications and surgery, and multivariable linear regression to examine the association between diagnostic delay and growth. Predictors of diagnostic delay were identified using Cox PH regression.
RESULTS
Overall (64% Crohn's disease [CD]; 36% ulcerative colitis/IBD unclassified [UC/IBD-U]; 57% male]), median time to diagnosis was 4.2 (interquartile range [IQR] 2.0-9.2) months. For the overall cohort, diagnostic delay was >9.2 months; in CD, >10.8 months and in UC/IBD-U, >6.6 months. In CD, diagnostic delay was associated with a 2.5-fold higher rate of strictures/internal fistulae (hazard ratio [HR] 2.53, 95% confidence interval [CI] 1.41-4.56). Every additional month of diagnostic delay was associated with a decrease in height-for-age z-score of 0.013 standard deviations [95% CI 0.005-0.021]. Associations persisted after adjusting for disease location and therapy. No independent association was observed between diagnostic delay and surgery in CD or UC/IBD-U. Diagnostic delay was more common in CD, particularly small bowel CD. Abdominal pain, including isolated abdominal pain in CD, was associated with diagnostic delay.
CONCLUSIONS
Diagnostic delay represents a risk factor for stricturing/internal fistulising complications and growth impairment in paediatric CD.
PODCAST
This article has an associated podcast which can be accessed at https://academic.oup.com/ecco-jcc/pages/podcast.
背景
儿科领域关于诊断延迟与炎症性肠病[IBD]并发症之间关联的资料较为缺乏。我们旨在确定在一个大型儿科队列中，诊断延迟对狭窄/瘘管并发症、手术和生长受损的影响，并确定诊断延迟的预测因素。
方法
我们开展了一项全国性、前瞻性、多中心 IBD 发病队列研究，纳入了 1399 名儿童。诊断延迟定义为从症状出现到诊断的时间>第 75 个百分位数。多变量比例风险[PH]回归用于检验诊断延迟与狭窄/瘘管并发症和手术之间的关联，多变量线性回归用于检验诊断延迟与生长之间的关联。使用 Cox PH 回归确定诊断延迟的预测因素。
结果
总体（64%克罗恩病[CD]；36%溃疡性结肠炎/IBD 未分类[UC/IBD-U]；57%为男性]），中位诊断时间为 4.2（四分位距[IQR] 2.0-9.2）个月。对于整个队列，诊断延迟>9.2 个月；在 CD 中，>10.8 个月；在 UC/IBD-U 中，>6.6 个月。在 CD 中，诊断延迟与狭窄/内瘘的发生率增加 2.5 倍相关（风险比[HR] 2.53，95%置信区间[CI] 1.41-4.56）。每增加一个月的诊断延迟与身高-年龄 z 评分降低 0.013 个标准差[95%CI 0.005-0.021]相关。在调整疾病部位和治疗后，这些关联仍然存在。在 CD 或 UC/IBD-U 中，诊断延迟与手术之间没有独立的关联。CD 中诊断延迟更为常见，尤其是小肠 CD。腹痛，包括 CD 中的孤立性腹痛，与诊断延迟相关。
结论
诊断延迟是儿科 CD 狭窄/内瘘并发症和生长受损的危险因素。
Zotero 插件