血清学优化指标在克罗恩病黏膜愈合判断中的诊断效能

Efficacy of serological optimizing markers in monitoring mucosal healing in Crohn′s disease

目的研究血清白蛋白(ALB)、C-反应蛋白(CRP)、血小板计数(PLT)及血清学优化指标PLT/ALB、CRP/ALB在判断经治疗已达到临床缓解期的克罗恩病患者是否达到内镜下黏膜愈合的诊断效能。方法对2000年1月至2017年12月在南方医科大学南方医院已确诊克罗恩病且经治疗已达到临床愈合(CDAI<150分)的75例患者进行回顾性分析,根据肠镜SES-CD评分是否小于2分,分为黏膜愈合组与非黏膜愈合组。对比患者一般资料、血清学资料及SES-CD评分,通过ROC曲线评估各项指标对黏膜愈合判断的诊断效能。结果与非黏膜愈合组患者相比,黏膜愈合组ALB较高,PLT、PLT/ALB、CRP和CRP/ALB较低。其中ALB、CRP、CRP/ALB和PLT/ALB在治疗前后均与SES-CD评分存在显著相关性。ROC曲线分析,在诊断黏膜愈合的效能方面,各指标诊断黏膜愈合的敏感度、特异度如下:ALB(敏感度84.4%,特异度55.8%)、CRP(敏感度81.4%,特异度68.7%)、PLT(敏感度76.7%,特异度56.2%)。当血清学指标优化后使用时,正确指数高于相应的单个血清学指标,其中CRP/ALB诊断正确指数最高,当CRP/ALB<0.147时诊断黏膜愈合的敏感度79.1%,特异度71.9%。结论血清学指标ALB、CRP、PLT均能在一定程度上判断克罗恩病患者是否处于黏膜愈合状态,但血清学优化指标CRP/ALB的诊断效果最佳,优于单用血清学指标。

Objective To investigate the relationship between serum albumin（ALB）, C-reactive protein（CRP）, platelet count（PLT）, PLT/ALB, CRP/ALB and mucosal healing（MH） in patients with Crohn′s disease who have achieved clinical remission, and to evaluate their efficacy in monitoring mucosal healing. Methods Retrospective analysis was performed on 75 Crohn′s disease patients who had been treated for clinical healing in the Southern Hospital of Southern Medical University from January 2000 to December 2017. According to whether achieving mucosal healing, the patients were divided into two groups. General information of patients,serologic data, and SES-CD scores in two groups were compared, and the ROC curve was used to evaluate the diagnostic efficacy of each serological markers for monitoring mucosal healing. Results ALB in the mucosal healing group was higher than that in the non-mucosal healing group, and PLT, PLT/ALB, CRP, and CRP/ALB were lower. Among them, ALB, CRP, CRP/ALB, and PLT/ALB were significantly associated with colonoscopy scores before and after treatment. In the efficacy of serological markers in monitoring MH, ALB（sensitivity 84.4%, specificity 55.8%）, CRP（sensitivity 81.4%, specificity 68.7%）, PLT（sensitivity 76.7%,specificity 56.2%）. It seems that when the serological indicators were used in combination, the correct index was higher than that of a single serological indicator. And CRP/ALB had the highest correct index in diagnosis of MH, when CRP/ALB was less 0.147, the sensitivity of the diagnosis of MH is 79.1%, specificity is 71.9%.Conclusion Serological markers including ALB, CRP, PLT can partly determine whether the patients with Crohn′s disease are in the state of mucosal healing. However, the serological optimization index CRP/ALB has the best diagnostic effect, which is superior to the serological index alone.