Hu Yudie, Lv Yao, Lou Jingan, Luo Youyou, Yang Gan, Liu Yang, Zhou Jiaying, Zhen Changjun, Yu Jindan, Fang Youhong, Zhao Hong, Peng Kerong, Ni Yan, Chen Jie
Gastroenterology Department, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, 3333 Bin Sheng Rd, Bin Jiang District, Hangzhou, Zhejiang, 310052, China.
Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, 310052, China.
BMC Pediatr. 2025 Mar 17;25(1):206. doi: 10.1186/s12887-025-05497-9.
Exclusive enteral nutrition (EEN) is recommended as first-line therapy for children with mild to moderate Crohn's disease (CD), given its effectiveness in inducing clinical remission (CR) and promoting mucosal healing (MH). However, the identification of reliable early predictors of EEN response remains an area requiring further investigation.
Patients with CD diagnosed between 2015 and 2024 were divided into training and validation cohorts. Baseline clinical and laboratory covariates were analyzed separately to evaluate their associations with CR and MH after 8 weeks of EEN therapy. Significant covariates were identified through univariate analysis and correlation tests, followed by their inclusion in stepwise logistic regression to develop separate predictive models for CR and MH. Model performance was evaluated using receiver operating characteristic (ROC) curves.
A total of 56 patients were included in the derivation cohort, and 28 were included in the validation cohort. The CR diagnostic model achieved an Area Under Curve (AUC) of 0.93 in the derivation cohort (95% confidence interval (CI) 0.87-1.00; p < 0.05) and 0.82 in the validation cohort (95% CI 0.62-1.02; p < 0.05). Higher baseline levels of IBIL (> 4.95 µmol/L), T-cell cluster of differentiation 3 (CD3) (> 76.78%), and iron (> 9.025 mmol/L) were associated with reduced CR rates. The MH diagnostic model yielded an AUC of 0.87 in the derivation cohort (95% CI 0.73-1.00; p < 0.05) and 0.66 in the validation cohort (95% CI 0.43-0.89; p = 0.231). Factors associated with lower MH rates included an Interleukin 10 (IL-10) level > 4.35 µmol/L and a red cell distribution width (RDW) > 14.55%.
IBIL, CD3 and iron levels are reliable predictors of the induction of CR with EEN, whereas the IL-10 level and RDW serve as early predictors of MH.
鉴于全肠内营养（EEN）在诱导临床缓解（CR）和促进黏膜愈合（MH）方面的有效性，它被推荐作为轻至中度克罗恩病（CD）儿童的一线治疗方法。然而，确定EEN反应的可靠早期预测指标仍是一个需要进一步研究的领域。
将2015年至2024年期间诊断为CD的患者分为训练队列和验证队列。分别分析基线临床和实验室协变量，以评估它们与EEN治疗8周后的CR和MH的相关性。通过单变量分析和相关性检验确定显著协变量，然后将其纳入逐步逻辑回归，以建立CR和MH的单独预测模型。使用受试者工作特征（ROC）曲线评估模型性能。
推导队列共纳入56例患者，验证队列纳入28例患者。CR诊断模型在推导队列中的曲线下面积（AUC）为0.93（95%置信区间（CI）0.87-1.00；p<0.05），在验证队列中为0.82（95%CI 0.62-1.02；p<0.05）。较高的基线总胆红素（IBIL）水平（>4.95µmol/L）、T细胞分化簇3（CD3）水平（>76.78%）和铁水平（>9.025mmol/L）与较低的CR率相关。MH诊断模型在推导队列中的AUC为0.87（95%CI 0.73-1.00；p<0.05），在验证队列中为0.66（95%CI 0.43-0.89；p=0.231）。与较低MH率相关的因素包括白细胞介素10（IL-10）水平>4.35µmol/L和红细胞分布宽度（RDW）>14.55%。
IBIL、CD3和铁水平是EEN诱导CR的可靠预测指标，而IL-10水平和RDW可作为MH的早期预测指标。
