Klamt Juliane, de Laffolie Jan, Wirthgen Elisa, Stricker Sebastian, Däbritz Jan
Rostock Medical School, University of Rostock, Rostock, Germany.
Department of Pediatrics, Justus Liebig University Giessen, Giessen, Germany.
Front Pediatr. 2023 Feb 15;11:1043067. doi: 10.3389/fped.2023.1043067. eCollection 2023.
Complications of Crohn's disease (CD) often impair patients' quality of life. It is necessary to predict and prevent these complications (surgery, stricturing [B2]/penetrating [B3] disease behavior, perianal disease, growth retardation and hospitalization). Our study investigated previously suggested and additional predictors by analyzing data of the CEDATA-GPGE registry.
Pediatric patients (< 18 years) diagnosed with CD with follow up data in the registry were included in the study. Potential risk factors for the selected complications were evaluated by performing Kaplan-Meier survival curves and cox regression models.
For the complication surgery, the potential risk factors older age, B3 disease, severe perianal disease and initial therapy with corticosteroids at the time of diagnosis were identified. Older age, initial therapy with corticosteroids, low weight-for-age, anemia and emesis predict B2 disease. Low weight-for-age and severe perianal disease were risk factors for B3 disease. Low weight-for-age, growth retardation, older age, nutritional therapy, and extraintestinal manifestations (EIM) of the skin were identified as risk factors for growth retardation during the disease course. High disease activity and treatment with biologicals were predictors for hospitalization. As risk factors for perianal disease, the factors male sex, corticosteroids, B3 disease, a positive family history and EIM of liver and skin were identified.
We confirmed previously suggested predictors of CD course and identified new ones in one of the largest registries of pediatric CD patients. This may help to better stratify patients' according to their individual risk profile and choose appropriate treatment strategies.
克罗恩病（CD）的并发症常损害患者的生活质量。预测和预防这些并发症（手术、狭窄[B2]/穿透性[B3]疾病行为、肛周疾病、生长发育迟缓及住院）很有必要。我们的研究通过分析CEDATA - GPGE注册中心的数据，对先前提出的及其他预测因素进行了调查。
本研究纳入了在注册中心有随访数据的18岁以下诊断为CD的儿科患者。通过绘制Kaplan - Meier生存曲线和Cox回归模型评估所选并发症的潜在风险因素。
对于手术并发症，确定了年龄较大、B3疾病、严重肛周疾病以及诊断时初始使用皮质类固醇治疗等潜在风险因素。年龄较大、初始使用皮质类固醇治疗、年龄别体重低、贫血和呕吐可预测B2疾病。年龄别体重低和严重肛周疾病是B3疾病的风险因素。年龄别体重低、生长发育迟缓、年龄较大、营养治疗以及皮肤的肠外表现（EIM）被确定为疾病过程中生长发育迟缓的风险因素。疾病活动度高和使用生物制剂治疗是住院的预测因素。作为肛周疾病的风险因素，确定了男性、皮质类固醇、B3疾病、家族史阳性以及肝脏和皮肤的EIM等因素。
我们在最大的儿科CD患者注册中心之一中证实了先前提出的CD病程预测因素，并发现了新的预测因素。这可能有助于根据患者的个体风险特征更好地进行分层，并选择合适的治疗策略。
