不同内镜评分法评估儿童克罗恩病疾病活动度的价值

Value of different endoscopic scoring methods in assessing disease activity in pediatric Crohn's disease

目的探讨不同内镜评分法在评估儿童克罗恩病(Crohn's disease,CD)疾病活动度中的价值。方法收集2018年1月—2023年1月于重庆医科大学附属儿童医院明确诊断的CD患儿70例,根据儿童克罗恩病活动指数(Pediatric Crohn's Disease Activity Index,PCDAI)对患儿进行临床疾病活动度评分,根据内镜下表现进行内镜镜评分。采用Spearman秩相关分析评价各内镜评分方法与PCDAI及实验室指标之间的相关性,采用Kappa检验评价结肠镜及胶囊内镜评分法与PCDAI判断CD活动度的一致性,采用受试者操作特征曲线分析实验室指标预测内镜下活动度的诊断效能。结果PCDAI得分与克罗恩病内镜下严重程度指数(Crohn's Disease Endoscopic Index of Severity,CDEIS)得分(r_(s)=0.696,P<0.01)、克罗恩病简化内镜评分(Simple Endoscopic Score for Crohn's Disease,SES-CD)得分(r_(s)=0.680,P<0.01)、Lewis评分得分(r_(s)=0.540,P<0.01)及胶囊内镜克罗恩病指数(Capsule Endoscopy-Crohn's Disease Index,CE-CD)得分(r_(s)=0.502,P<0.01)均呈中度正相关。所有内镜评分法与PCDAI在判断CD活动度中的一致性较差(Kappa=0.069~0.226)。红细胞沉降率(erythrocyte sedimentation rate,ESR)、C反应蛋白(C-reactive protein,CRP)、血细胞比容(hematocrit,HCT)、血清白蛋白(serum albumin,ALB)水平与PCDAI得分、结肠镜评分法(CDEIS、SES-CD)得分均呈中度相关(|r_(s)|=0.581~0.725,P<0.01),与各胶囊内镜评分法得分相关性弱(P<0.05)。ESR、CRP预测PCDAI、CDEIS、SES-CD、Lewis评分下CD疾病活动的曲线下面积高于HCT、ALB(P<0.05)。结论内镜评分法中CDEIS、SES-CD、Lewis评分、CE-CD可用于评估儿童CD是否存在疾病活动,但与PCDAI评估下的疾病活动度不完全一致。ESR、CRP水平升高可预测临床及内镜下儿童CD疾病活动。

Objective To explore the value of different endoscopic scoring methods in assessing disease activity in pediatric Crohn's disease(CD).Methods A total of 70 children diagnosed with CD at the Children's Hospital of Chongqing Medical University from January 2018 to January 2023 were included.Clinical disease activity was assessed using the Pediatric Crohn's Disease Activity Index(PCDAI),while different endoscopic scores were assigned based on endoscopic findings.Spearman rank correlation analysis was used to evaluate the correlation between each endoscopic scoring method and PCDAI as well as laboratory indicators.Kappa test was used to assess the consistency between colonoscopy/capsule endoscopy scoring methods and PCDAI in determining CD activity.Receiver operating characteristic curve analysis was performed to assess the diagnostic efficacy of laboratory indicators in predicting endoscopic activity.Results The PCDAI score showed a moderate positive correlation with the scores of Crohn's Disease Endoscopic Index of Severity(CDEIS)(r_(s)=0.696,P<0.01),Simple Endoscopic Score for Crohn's Disease(SESCD)(r_(s)=0.680,P<0.01),Lewis Score(r_(s)=0.540,P<0.01),and Capsule Endoscopy-Crohn's Disease Index(CE-CD)(r_(s)=0.502,P<0.01).The consistency between all endoscopic scoring methods and PCDAI in determining CD activity was poor(Kappa=0.069-0.226).Erythrocyte sedimentation rate(ESR),C-reactive protein(CRP),hematocrit(HCT),and serum albumin(ALB)levels showed a moderate correlation with the PCDAI score and the scores of colonoscopy scoring methods(CDEIS and SES-CD)(|r_(s)|=0.581-0.725,P<0.01),but a weak correlation with the scores of capsule scoring methods(P<0.05).ESR and CRP had higher area under the curve(AUC)values in predicting disease activity based on PCDAI,CDEIS,SES-CD,and Lewis Score compared to HCT and ALB(P<0.05).Conclusions CDEIS,SES-CD,Lewis Score,and CE-CD can be used to evaluate disease activity in pediatric CD,but they do not fully correspond with disease activity assessed by PCDAI.Elevated levels of ESR and CRP can predict clinical and endoscopic disease activity in children with CD.