Kurowski Jacob A, Patel Sonal R, Wechsler Joshua B, Izaguirre Marisa R, Morgan Gabrielle A, Pachman Lauren M, Brown Jeffrey B
Department of Pediatric Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic, Cleveland, Ohio, USA.
Department of Pediatric Gastroenterology, Hepatology, and Nutrition, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.
Crohns Colitis 360. 2021 Oct 29;3(4):otab069. doi: 10.1093/crocol/otab069. eCollection 2021 Oct.
Noninvasive screening and disease monitoring are an unmet need in pediatric inflammatory bowel disease (IBD). Nailfold capillaroscopy (NFC) is a validated technique for microvascular surveillance in rheumatologic diseases. NFC uses magnified photography to examine nail bed capillaries called end row loops (ERL). We aimed to identify variations in NFC in pediatric IBD patients and their associations with disease activity.
Pediatric patients with Crohn's disease (CD) or ulcerative colitis (UC) and healthy controls were recruited. NFC was performed on patients with newly diagnosed IBD prior to initiating therapy, patients with established IBD, and controls. ERLs were quantified along with a 3mm distance on 8 nailfolds. Serum biomarker levels of disease activity and symptoms activity indexes were correlated with average ERL density digits on both hands. Statistics were performed using chi-squared, ANOVA, and linear regression.
Fifty-one IBD patients and 16 controls were recruited. ERL density was significantly decreased in IBD (Control: 19.2 ERL/3mm vs UC: 15.6 ERL/3mm vs CD: 15.4 ERL/3mm; < .0001). ERL density was lower in UC patients with lower albumin levels ( = .02, = 0.29).The change in ERL density over time predicted the change in pediatric CD activity index among CD patients ( = .048, = 0.58) with treatment.
Our data demonstrate ERL density is reduced in IBD compared to controls. Lower albumin levels correlated with lower ERL density in UC. In newly diagnosed CD, ERL density increases over time as disease activity improves with therapy. NFC may be a feasible biomarker of disease activity and utilized for monitoring IBD.
无创筛查和疾病监测是儿科炎症性肠病（IBD）中尚未满足的需求。甲襞毛细血管镜检查（NFC）是一种用于风湿性疾病微血管监测的有效技术。NFC使用放大摄影来检查称为终末排襻（ERL）的甲床毛细血管。我们旨在确定儿科IBD患者NFC的变化及其与疾病活动的关联。
招募患有克罗恩病（CD）或溃疡性结肠炎（UC）的儿科患者以及健康对照。对新诊断的IBD患者在开始治疗前、已确诊的IBD患者和对照进行NFC检查。在8个甲襞上对ERL进行定量，并测量3毫米距离。疾病活动的血清生物标志物水平和症状活动指数与双手平均ERL密度指数量相关。使用卡方检验、方差分析和线性回归进行统计分析。
招募了51例IBD患者和16例对照。IBD患者的ERL密度显著降低（对照：19.2个ERL/3毫米，UC：15.6个ERL/3毫米，CD：15.4个ERL/3毫米；P<0.0001）。白蛋白水平较低的UC患者的ERL密度较低（P = 0.02，r = 0.29）。随着时间推移，ERL密度的变化预测了CD患者在治疗期间儿科CD活动指数的变化（P = 0.048，r = 0.58）。
我们的数据表明，与对照相比，IBD患者的ERL密度降低。UC患者中较低的白蛋白水平与较低的ERL密度相关。在新诊断的CD中，随着疾病活动通过治疗改善，ERL密度随时间增加。NFC可能是一种可行的疾病活动生物标志物，可用于监测IBD。
