克罗恩病简化内镜评分(SES-CD)与临床和实验室指标相关性的研究

Correlation between Simplified Endoscopic Score for Crohn's Disease( SES-CD) and Clinical and Laboratory Markers in Patients with Crohn's Disease

背景:内镜活动性已被作为克罗恩病(CD)治疗的评估终点。CD简化内镜评分(SES-CD)是一种简单、易用的内镜评分方法,目前关于SES-CD与非侵入性炎症相关指标关系的研究尚少。目的:探讨SES-CD与临床和实验室炎症相关指标的相关性,确定适宜的判断CD内镜活动性的非侵入性指标。方法:纳入42例CD患者,行实验室炎症相关指标[白细胞(WBC)计数、血小板(PLT)计数、C-反应蛋白(CRP)、红细胞沉降率(ESR)、血红蛋白(Hb)、白蛋白(Alb)、粪便钙卫蛋白(FC)]检测和SES-CD、CD活动指数(CDAI)评估。以ROC曲线分析各项指标对CD内镜下活动的预测效能,分析SES-CD与各项指标的相关性。结果:活动期CD的PLT计数、CRP、ESR、FC、SES-CD显著高于缓解期CD,Hb和Alb显著低于缓解期CD(P均<0.05)。各项非侵入性指标中,仅CDAI和FC预测CD内镜下活动的ROC曲线下面积(AUC)在0.9以上;CDAI以≥150为界值、FC以正常上限(ULN,≥50μg/g)为界值,相应敏感性分别为58.8%和100%,特异性分别为100%和60.0%。SES-CD与CDAI、PLT计数、CRP、ESR、Alb、FC之间存在中度相关性(P均<0.05)。结论:SES-CD与临床和实验室炎症相关指标具有较好的相关性,但传统炎症相关指标CDAI、CRP、ESR以ULN为界值无法敏感、准确地反映CD内镜下活动,FC则有较高的准确性和敏感性,可作为非侵入性指标用于CD内镜活动性的评估。

Background：Endoscopic activity has been used as an endpoint in treatment of Crohn’s disease（CD）.Simplified Endoscopic Score for Crohn’s Disease（SES-CD）is a simple and easy-to-use endoscopic scoring system for CD,however,studies evaluating the correlation between SES-CD and noninvasive inflammatory markers are scarce.Aims：To investigate the correlation between SES-CD and clinical and laboratory inflammatory markers for identifying a noninvasive surrogate marker for endoscopic activity of CD.Methods：Forty-two patients with CD were enrolled for detecting laboratory inflammatory markers including leukocyte and platelet count,C-reactive protein（CRP）,erythrocyte sedimentation rate（ESR）,hemoglobin（Hb）,albumin（Alb）and fecal calprotectin（FC）;SES-CD and Crohn’disease activity index（CDAI）were assessed.Predictive performance of these markers for endoscopic activity of CD was analyzed by ROC curve,and the correlation of SES-CD with all these markers was evaluated.Results：The platelet count,CRP,ESR,FC and SES-CD were significantly higher in active CD than in inactive CD,while Hb and Alb were significantly lower in active CD（P all〈0.05）.In all the noninvasive markers,only CDAI and FC had an area under the curve（AUC）greater than 0.9for predicting CD endoscopic activity.Taken 150 as the cut-off value of CDAI and 50μg/g（the upper limit of normal,ULN）as the cut-off value of FC,the sensitivity of CDAI and FC were 58.8%and 100%,and the specificity were 100%and 60.0%,respectively.SES-CD had moderate correlation with CDAI,platelet count,CRP,ESR,Alb and FC,respectively（P all〈0.05）.Conclusions：SES-CD is correlated moderately with the clinical and laboratory inflammatory markers,however,when taken the ULN as cut-off value the conventional inflammatory markers such as CDAI,CRP andESR are hard to predict sensitively and accurately the endoscopic activity of CD;while FC has fairly high accuracy and sensitivity and can be used as a noninvasive surrogate marker for evaluating endoscopic activity of CD.