SickKids Inflammatory Bowel Disease Center, Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.
CHEO Inflammatory Bowel Disease Center, Division of Gastroenterology, Hepatology, and Nutrition, Children's Hospital of Eastern Ontario, Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada.
Am J Gastroenterol. 2021 Oct 1;116(10):2052-2059. doi: 10.14309/ajg.0000000000001400.
We aimed to evaluate the reliability and validity of the Ulcerative Colitis (UC) Endoscopic Index of Severity (UCEIS) and Mayo Endoscopy Score (MES) and to validate the Robarts Histopathology Index (RHI) and Nancy Index (NI) in pediatric UC. We examined rectosigmoid and pancolonic versions of each instrument.
Single-center cross-sectional study of 60 prospectively enrolled participants. Through central endoscopy review, 4 pediatric gastroenterologists assigned rectosigmoid and pancolonic (mean of 5 colonic segments) UCEIS and MES scores. Two blinded pathologists assigned rectosigmoid and pancolonic RHI and NI scores. We assessed reliability with intraclass correlation coefficients and weighted kappa statistics and explored construct validity with correlations, boxplots, and receiver operator characteristic curves.
The UCEIS and MES displayed almost perfect intra-rater and inter-rater reliability (intraclass correlation coefficient and weighted kappa ≥0.85), moderate-to-strong correlation with histologic/clinical activity and fecal calprotectin (FC), and very strong correlation with global endoscopic severity (r > 0.9). Rectosigmoid UCEIS and MES scores of 0 were highly specific (≥95%) for endoscopic and histologic remission throughout the colon. Pancolonic endoscopy scores correlated more strongly with histologic activity, clinical activity, and systemic inflammatory markers and better discriminated between degrees of active disease. RHI and NI showed moderate-to-strong correlation (r = 0.5-0.83) with endoscopic/clinical activity and FC.
Our findings support the reliability and construct validity of the UCEIS and MES and the construct validity of the RHI and NI in pediatric UC. Normal rectosigmoid findings predicted pancolonic healing, but, given active disease, pancolonic endoscopic assessment more accurately captured global disease burden.
本研究旨在评估溃疡性结肠炎内镜严重程度指数（UCEIS）和 Mayo 内镜评分（MES）的可靠性和有效性，并验证小儿溃疡性结肠炎的 Robarts 组织病理学指数（RHI）和 Nancy 指数（NI）。我们对直肠乙状结肠和全结肠版本的每种仪器进行了检查。
这是一项单中心的前瞻性研究，共纳入 60 名参与者。通过中心内镜评估，4 名儿科胃肠病学家分别对直肠乙状结肠和全结肠（平均 5 个结肠节段）UCEIS 和 MES 进行评分。两位盲法病理学家分别对直肠乙状结肠和全结肠的 RHI 和 NI 进行评分。我们使用组内相关系数和加权 kappa 统计评估可靠性，并通过相关性、箱线图和受试者工作特征曲线探索结构效度。
UCEIS 和 MES 显示出几乎完美的内部和外部评分者可靠性（组内相关系数和加权 kappa 值≥0.85），与组织学/临床活动和粪便钙卫蛋白（FC）具有中度至强相关性，与整体内镜严重程度具有极强相关性（r > 0.9）。直肠乙状结肠 UCEIS 和 MES 评分为 0 时，在整个结肠的内镜和组织学缓解方面具有很高的特异性（≥95%）。全结肠的内镜评分与组织学活动、临床活动和全身炎症标志物的相关性更强，并且能更好地区分疾病活动度的程度。RHI 和 NI 与内镜/临床活动和 FC 具有中度至强相关性（r = 0.5-0.83）。
本研究结果支持 UCEIS 和 MES 的可靠性和结构效度，以及 RHI 和 NI 在小儿溃疡性结肠炎中的结构效度。正常的直肠乙状结肠发现预测了全结肠愈合，但在存在活动病变的情况下，全结肠内镜评估更准确地反映了疾病的总体负担。
