利用超声评估小儿克罗恩病的疾病活动度：小儿克罗恩病肠道超声评分。

Assessing Disease Activity in Pediatric Crohn's Disease Using Ultrasound: The Pediatric Crohn Disease Intestinal Ultrasound Score.

机构信息

From the Pediatric Gastroenterology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.

the Amsterdam Reproduction & Development Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.

出版信息

J Pediatr Gastroenterol Nutr. 2023 May 1;76(5):582-589. doi: 10.1097/MPG.0000000000003727. Epub 2023 Feb 7.

DOI:10.1097/MPG.0000000000003727

PMID:36754087

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10097488/

Abstract

OBJECTIVES

Currently, there is no consensus on how to score Crohn disease (CD) activity assessed by intestinal ultrasound (IUS) in children. This study aimed to design an easy-to-use IUS score for disease activity in pediatric CD.

METHODS

Children undergoing ileo-colonoscopy for CD assessment underwent IUS the day before ileo-colonoscopy, assessed with simple endoscopic score for CD (SES-CD). IUS features were compared to the SES-CD on segmental level. Multiple regression analyses, separately for terminal ileum (TI) and colon, were done to assess predictors of disease activity and to develop a model.

RESULTS

In 74 CD patients (median 15 years, 48% female), 67 TI and 364 colon segments were assessed. Based on receiver operating characteristics curves, bowel wall thickness (BWT) was categorized into low [1 point: 2-3 mm (TI) and 1.6-2 mm (colon)], medium [2 points: 3.0-3.7 mm (TI) and 2.0-2.7 mm (colon)], and high [3 points: >3.7 mm (TI) and >2.7 mm (colon)]. In TI, only BWT was retained in the model [high BWT: odds ratio (OR) 11.50, P < 0.001]. In colon, BWT (high BWT: OR 8.63, P < 0.001) and mesenteric fat (1 point: OR 3.02, P < 0.001) were independent predictors. A pediatric Crohn disease IUS score (PCD-US) cut-off of 1 resulted in a sensitivity of 82% (95% confidence interval, CI: 65%-93%) and 85% (95% CI: 80%-89%) and a cut-off of 3 in a specificity of 88% (72%-97%) and 92% (87%-96%) for TI and colon, respectively. Inter-observer agreement was moderate for TI and colon ( K : 0.42, K : 0.49, respectively).

CONCLUSIONS

The PCD-US score is an easy-to-use and reliable score to detect or rule out CD activity on segmental level in children. External validation is needed before applying this score in clinical practice.

摘要

目的

目前，对于儿童肠超声（IUS）评估克罗恩病（CD）活动，尚无共识如何评分。本研究旨在设计一种简单易用的儿童 CD 疾病活动 IUS 评分。

方法

接受回结肠镜检查评估 CD 的患儿，在回结肠镜检查前一天进行 IUS 检查，采用简单内镜 CD 评分（SES-CD）进行评估。在节段水平上比较 IUS 特征与 SES-CD。分别对回肠末端（TI）和结肠进行多元回归分析，以评估疾病活动的预测因子并建立模型。

结果

在 74 例 CD 患儿（中位数年龄 15 岁，48%为女性）中，评估了 67 个 TI 段和 364 个结肠段。根据受试者工作特征曲线，肠壁厚度（BWT）分为低 [1 分：2-3mm（TI）和 1.6-2mm（结肠）]、中 [2 分：3.0-3.7mm（TI）和 2.0-2.7mm（结肠）] 和高 [3 分：>3.7mm（TI）和>2.7mm（结肠）]。在 TI 中，只有 BWT 保留在模型中[高 BWT：比值比（OR）11.50，P<0.001]。在结肠中，BWT（高 BWT：OR 8.63，P<0.001）和肠系膜脂肪（1 分：OR 3.02，P<0.001）是独立的预测因子。PCD-US 评分的截断值为 1 时，TI 和结肠的敏感性分别为 82%（95%置信区间，CI：65%-93%）和 85%（95%CI：80%-89%），截断值为 3 时，特异性分别为 88%（72%-97%）和 92%（87%-96%）。TI 和结肠的观察者间一致性为中度（ K ：0.42， K ：0.49）。