Department of Gastroenterology, Affiliated Hospital of Yangzhou University, Yangzhou, 225009, Jiangsu, China.
Medical College of Yangzhou University, Jiangsu, China.
BMC Gastroenterol. 2023 Sep 28;23(1):337. doi: 10.1186/s12876-023-02968-0.
Mucosal healing has become the primary treatment target for patients with Crohn's disease (CD). We aimed to develop a noninvasive and convenient tool to evaluate the endoscopic activity in patients with ileocolic CD.
A retrospective multicenter study including 300 CD patients (training, 210 patients; test, 90 patients) was conducted at two tertiary referral centers. Independent risk factors associated with endoscopic activity were explored, which were then combined into a comprehensive index. The predictive performance was evaluated with the area under receiver operating characteristic curve (ROC). Cohen's Kappa was adopted to examine the consistency between each indicator and endoscopic activity.
A total of 210 CD patients were recruited in the training cohort. We found that Crohn's Disease Activity Index (CDAI), C-reactive protein (CRP) and platelet-to-lymphocyte percentage ratio (PLpR) were independently associated with endoscopic activity. Additionally, the comprehensive index generated from the above three indices achieved good discrimination and performed better than CDAI in AUC (0.849 vs. 0.769, P < 0.05). This was further well demonstrated by the external test cohort, which showed good discrimination (AUC: 0.84, 95% CI: 0.744-0.936). Intra-individual comparison revealed the comprehensive index to be superior in the prediction of endoscopic activity. In the subgroup analysis, the AUC of comprehensive index was significantly higher than CDAI especially in inflammatory phenotype (0.824 vs. 0.751, P < 0.05).
Combining CDAI, CRP and PLpR significantly improved the accuracy for predicting endoscopic activity in ileocolic CD, which can help better monitor an endoscopic flare.
黏膜愈合已成为克罗恩病（CD）患者的主要治疗目标。我们旨在开发一种非侵入性且方便的工具来评估回肠结肠 CD 患者的内镜活动。
在两个三级转诊中心进行了一项回顾性多中心研究，共纳入 300 例 CD 患者（训练队列 210 例，测试队列 90 例）。探讨与内镜活动相关的独立危险因素，并将其组合成综合指数。采用接受者操作特征曲线（ROC）下面积评估预测性能。采用 Cohen's Kappa 检验评估各指标与内镜活动的一致性。
共纳入 210 例 CD 患者进入训练队列。我们发现克罗恩病活动指数（CDAI）、C 反应蛋白（CRP）和血小板与淋巴细胞比值（PLpR）与内镜活动独立相关。此外，由上述三个指标生成的综合指数具有良好的区分度，在 AUC 方面优于 CDAI（0.849 比 0.769，P<0.05）。这在外测队列中得到了进一步证实，其 AUC 为 0.84（95%CI：0.744-0.936），具有良好的区分度。个体内比较显示综合指数在预测内镜活动方面具有优势。亚组分析显示，综合指数的 AUC 明显高于 CDAI，尤其是在炎症表型中（0.824 比 0.751，P<0.05）。
联合 CDAI、CRP 和 PLpR 可显著提高对回肠结肠 CD 内镜活动的预测准确性，有助于更好地监测内镜下的炎症发作。
