Value of patient-reported outcome score combined with serological indicators in evaluating endoscopic disease activity of patients with Crohn's disease
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摘要:目的
分析患者报告结局(PRO)评分联合血清学指标对克罗恩病(CD)内镜下疾病活动度的评估价值。
方法收集CD患者的临床资料, 分析PRO评分与CD简化内镜评分(SES-CD)的相关性。根据SES-CD结果将患者分为活动期组和缓解期组，比较2组临床资料，分析与内镜下疾病活动度相关的独立危险因素。应用受试者工作特征(ROC)曲线分析各指标单独及联合检测对内镜下疾病活动度的评估价值。
结果PRO评分与SES-CD呈轻度正相关(r=0.394, P < 0.001)。活动期组患者血小板(PLT)、红细胞分布宽度(RDW)、血小板压积(PCT)、C反应蛋白(CRP)、红细胞沉降率(ESR)、PRO评分高于缓解期组，淋巴细胞比率(LY)、红细胞压积(HCT)、平均红细胞体积(MCV)、血小板分布宽度(PDW)、平均血小板体积(MPV)、白蛋白(ALB)低于缓解期组，差异均有统计学意义(P < 0.05或P < 0.01)。多因素Logistic回归分析显示，PRO评分、ESR和RDW是内镜下疾病活动度的独立危险因素(P < 0.05)。ROC曲线显示, PRO评分联合ESR和RDW评估CD内镜下疾病活动度的灵敏度为80.5%, 特异度为90.0%, 曲线下面积为0.774(P < 0.001)。
结论PRO评分联合ESR和RDW能提高CD患者内镜下疾病活动度的预测准确性，是便捷且可靠的非侵入性评估指标。
Abstract:ObjectiveTo analyze the value of patient-reported outcome (PRO) score combined with serological indicators in evaluating endoscopic disease activity of patients with Crohn's disease (CD).
MethodsThe clinical materials of CD patients were collected, and the correlation between PRO score and Simplified Endoscopic Score for CD (SES-CD) was analyzed. According to the SES-CD result, the patients were divided into active phase group and remission phase group, the clinical materials were compared between the two groups, and the independent risk factors related to endoscopic disease activity were analyzed. The receiver operating characteristic (ROC) curve was used to analyze the value of evaluation for endoscopic disease activity by each single index and their combination.
ResultsThe PRO score was slightly positively correlated with SES-CD (r=0.394, P < 0.001). The platelet (PLT), red blood cell distribution width (RDW), plateletcrit (PCT), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and PRO score of the patients in the active phase group were significantly higher than those in the remission phase group, while the lymphocyte ratio (LY), hematocrit (HCT), mean red blood cell volume (MCV), platelet distribution width (PDW), mean platelet volume (MPV) and albumin (ALB) were significantly lower than those in the remission phase group (P < 0.05 or P < 0.01). Multivariate Logistic regression analysis showed that PRO score, ESR and RDW were independent risk factors for endoscopic disease activity (P < 0.05). ROC curve showed that the sensitivity, specificity and area under the curve of PRO score combined with ESR and RDW in evaluating the endoscopic disease activity of CD patients were 80.5%, 90.0% and 0.774, respectively (P < 0.001).
ConclusionPRO score combined with ESR and RDW can increase the prediction accuracy of endoscopic disease activity in patients with CD, and is a convenient and reliable non-invasive evaluation index.
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表 1 活动期组与缓解期组临床资料比较(x±s)[M(P25, P75)]
变量 全组(n=224) 缓解期组(n=60) 活动期组(n=164) WBC/(×109/L) 5.6(4.3, 7.2) 5.4(4.3, 6.4) 5.6(4.4, 7.3) NEUR/% 67.4(59.5, 73.7) 65.8(57.5, 72.4) 68.0(59.9, 74.7) LY/% 22.8(17.0, 29.8) 24.7(19.5, 33.7) 22.5(16.6, 29.0)* PLT/(×109/L) 233.0(189.8, 302.3) 201.0(171.3, 243.5) 249.0(200.8, 323.0)** RBC/(×1012/L) 4.4(4.0, 4.9) 4.7(4.0, 5.0) 4.4(4.0, 4.8) HCT/% 37.9(34.2, 42.9) 41.0(36.6, 44.8) 37.3(33.3, 41.7)** MCV/fL 86.5(82.0, 91.9) 90.3(86.3, 93.1) 85.5(80.2, 91.0)** RDW/% 13.2(12.4, 14.9) 12.8(12.1, 13.4) 13.5(12.6, 15.3)** PDW/% 14.5(11.6, 16.0) 15.6(12.6, 16.4) 13.8(11.2, 15.9)** PCT/% 0.2(0.2, 0.3) 0.2(0.2, 0.3) 0.3(0.2, 0.3)** MPV/fL 10.2(9.2, 11.1) 10.7(9.8, 11.8) 9.9(9.1, 10.7)** ALB/(g/L) 39.3(34.7, 43.2) 41.0(37.8, 44.1) 38.5(33.3, 42.7)** CRP/(mg/L) 10.3(1.6, 29.6) 1.7(0.5, 9.2) 13.7(4.0, 33.0)** ESR/(mm/h) 17.5(7.8, 38.3) 9.0(3.0, 22.0) 22.0(9.0, 46.0)** PRO评分/分 73.2±38.0 53.4±33.6 80.5±37.1** WBC: 白细胞; NEUR: 中性粒细胞比率; LY: 淋巴细胞比率; PLT: 血小板; RBC: 红细胞; HCT: 红细胞压积;
MCV: 平均红细胞体积; RDW: 红细胞分布宽度; PDW: 血小板分布宽度; PCT: 血小板压积; MPV: 平均血小板体积;
ALB: 白蛋白; CRP: C反应蛋白; ESR: 红细胞沉降率; PRO: 患者报告结局。与缓解期组比较, *P < 0.05, **P < 0.01。
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表 2 内镜下疾病活动度的多因素Logistic回归分析
变量 B SE Wald P OR 95%CI LY -0.018 0.014 1.595 0.207 0.982 0.956~1.010 HCT 0.034 0.037 0.838 0.360 1.035 0.962~1.113 MCV 0.032 0.026 1.548 0.213 1.033 0.982~1.086 RDW 0.422 0.151 7.812 0.005 1.525 1.134~2.049 PDW -0.115 0.073 2.486 0.115 0.891 0.772~1.028 MPV -0.228 0.146 2.434 0.119 0.796 0.598~1.060 ALB -0.025 0.048 0.282 0.595 0.975 0.888~1.071 CRP -0.010 0.008 1.616 0.204 0.990 0.974~1.006 ESR 0.024 0.012 3.932 0.047 1.025 1.000~1.049 PRO 0.015 0.006 7.325 0.007 1.016 1.004~1.027
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表 3 各指标单独及联合预测内镜下疾病活动度的价值
变量 临界值 AUC 灵敏度/% 特异度/% 约登指数 P ESR/(mm/h) 25.5 0.705 43.9 85.0 0.289 < 0.001 RDW/% 13.4 0.667 54.3 75.0 0.293 < 0.001 PRO评分/分 49.5 0.708 78.8 55.0 0.337 < 0.001 联合指标 — 0.774 80.5 90.0 0.437 < 0.001 ESR: 红细胞沉降率; RDW: 红细胞分布宽度; PRO: 患者报告结局; AUC: 曲线下面积。
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