Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Clin Transl Sci. 2023 Sep;16(9):1639-1652. doi: 10.1111/cts.13575. Epub 2023 Jul 21.
Disease activity evaluation is important in Crohn's disease (CD). We aimed to establish new disease activity indices for CD based on noninvasive parameters. The data of 110 patients with CD were retrospectively analyzed. Parameters from bowel ultrasound and biomarkers were measured to select the variables included in the models by univariate analysis. Logistic regression analysis was performed to predict mucosal and transmural activities defined by ileocolonoscopy or computed tomography enterography, respectively. The models' performance was measured by the area under the receiver operating characteristic (ROC) curve (AUC). Leave-one-out cross validation (LOOCV) was applied to adjust for overconfidence in the newly established score models. To predict mucosal activity, erythrocyte sedimentation rate (ESR) and (LimG × BWT)-SUM (the sum of the product of Limberg grade [LimG] and bowel wall thickness [BWT] of each bowel segment) were selected for model A, and the equation was A = 2 × ESR + 9.3 × (LimG × BWT)-SUM. The AUC of ROC, sensitivity, and specificity were 0.927%, 89.8%, and 86.4%, respectively. The AUC of the ROC curve verified by LOOCV was 0.913. To predict transmural activity, albumin (ALB) and LimG-SUM (the sum of the LimG of all the bowel segments) were selected for model B, which was established as B = -1.3 × ALB +1.7 × LimG-SUM. The AUC of ROC, sensitivity, and specificity were 0.851%, 78.0%, and 84.2%, respectively. The AUC of the ROC curve verified by LOOCV was 0.833. Nomograms were developed for two score models. New score models based on noninvasive parameters established in this study showed good abilities in detecting active disease and performed well in the validation phase.
疾病活动评估在克罗恩病（CD）中很重要。我们旨在基于非侵入性参数为 CD 建立新的疾病活动指数。回顾性分析了 110 例 CD 患者的数据。通过单变量分析测量肠道超声和生物标志物参数，以选择纳入模型的变量。使用逻辑回归分析分别预测经回结肠镜或计算机断层扫描肠造影术定义的黏膜和透壁活动。通过接收者操作特征（ROC）曲线下面积（AUC）测量模型的性能。应用留一法交叉验证（LOOCV）调整新建立的评分模型的过度自信。为了预测黏膜活动，选择红细胞沉降率（ESR）和（LimG×BWT）-SUM（每个肠段的 Limberg 分级[LimG]和肠壁厚度[BWT]的乘积之和）用于模型 A，方程为 A=2×ESR+9.3×（LimG×BWT）-SUM。ROC 曲线的 AUC、敏感性和特异性分别为 0.927%、89.8%和 86.4%。经 LOOCV 验证的 ROC 曲线的 AUC 为 0.913。为了预测透壁活动，选择白蛋白（ALB）和 LimG-SUM（所有肠段的 LimG 之和）用于模型 B，建立为 B=-1.3×ALB+1.7×LimG-SUM。ROC 曲线的 AUC、敏感性和特异性分别为 0.851%、78.0%和 84.2%。经 LOOCV 验证的 ROC 曲线的 AUC 为 0.833。为两个评分模型开发了列线图。本研究基于非侵入性参数建立的新评分模型具有良好的检测活动性疾病的能力，并且在验证阶段表现良好。
