Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, China.
Department of Gastroenterology, The Second Affiliated Hospital of Soochow University, 1055 Sanxiang Road, Suzhou, China.
BMC Gastroenterol. 2022 May 10;22(1):229. doi: 10.1186/s12876-022-02304-y.
Mucosal healing (MH) has become the treatment goal of patients with Crohn's disease (CD). This study aims to develop a noninvasive and reliable clinical tool for individual evaluation of mucosal healing in patients with Crohn's disease.
A multicenter retrospective cohort was established. Clinical and serological variables were collected. Separate risk factors were incorporated into a binary logistic regression model. A primary model and a simple model were established, respectively. The model performance was evaluated with C-index, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy. Internal validation was performed in patients with small intestinal lesions.
A total of 348 consecutive patients diagnosed with CD who underwent endoscopic examination and review after treatment from January 2010 to June 2021 were composed in the derivation cohort, and 112 patients with small intestinal lesions were included in the validation cohort. The following variables were independently associated with the MH and were subsequently included into the primary prediction model: PLR (platelet to lymphocyte ratio), CAR (C-reactive protein to albumin ratio), ESR (erythrocyte sedimentation rate), HBI (Harvey-Bradshaw Index) score and infliximab treatment. The simple model only included factors of PLR, CAR and ESR. The primary model performed better than the simple one in C-index (87.5% vs. 83.0%, p = 0.004). There was no statistical significance between these two models in sensitivity (70.43% vs. 62.61%, p = 0.467), specificity (87.12% vs. 80.69%, p = 0.448), PPV (72.97% vs. 61.54%, p = 0.292), NPV (85.65% vs. 81.39%, p = 0.614), and accuracy (81.61% vs. 74.71%, p = 0.303). The primary model had good calibration and high levels of explained variation and discrimination in validation cohort.
This model can be used to predict MH in post-treatment patients with CD. It can also be used as an indication of endoscopic surveillance to evaluate mucosal healing in patients with CD after treatment.
黏膜愈合（MH）已成为克罗恩病（CD）患者的治疗目标。本研究旨在开发一种用于个体评估 CD 患者黏膜愈合的非侵入性和可靠的临床工具。
建立了一个多中心回顾性队列。收集临床和血清学变量。将单独的危险因素纳入二元逻辑回归模型。分别建立了主模型和简化模型。通过 C 指数、敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）和准确性评估模型性能。在小肠病变患者中进行内部验证。
纳入 2010 年 1 月至 2021 年 6 月接受治疗后进行内镜检查和复查的 348 例连续 CD 患者作为推导队列，纳入 112 例小肠病变患者作为验证队列。以下变量与 MH 独立相关，并随后纳入主要预测模型：血小板与淋巴细胞比值（PLR）、C 反应蛋白与白蛋白比值（CAR）、红细胞沉降率（ESR）、Harvey-Bradshaw 指数（HBI）评分和英夫利昔单抗治疗。简化模型仅包含 PLR、CAR 和 ESR 因素。主要模型在 C 指数（87.5%比 83.0%，p=0.004）方面优于简化模型。这两个模型在敏感性（70.43%比 62.61%，p=0.467）、特异性（87.12%比 80.69%，p=0.448）、PPV（72.97%比 61.54%，p=0.292）、NPV（85.65%比 81.39%，p=0.614）和准确性（81.61%比 74.71%，p=0.303）方面无统计学意义。在验证队列中，主要模型具有良好的校准度和高水平的解释变异和区分度。
该模型可用于预测治疗后 CD 患者的 MH，也可作为内镜监测的指征，用于评估治疗后 CD 患者的黏膜愈合情况。
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