CESI、简化CDAI和CRP在评估小肠克罗恩病病变范围和活动程度中的应用价值

背景：小肠克罗恩病（CD）是一种慢性、反复发作性疾病。目前胶囊内镜评分指数（CESI）、简化CDAI和CRP在评估小肠CD病变范围和活动程度中的应用价值的研究甚少。目的：探讨CESI、简化CDAI和CRP在评估小肠CD病变范围和活动程度中的应用价值。方法：纳入行胶囊内镜检查并最终确诊为小肠CD的患者58例。分析简化CDAI和CRP与小肠病变范围的关系：评估小肠CD患者临床特征与CESI的相关性：计算简化CDAI和CRP判断胶囊内镜下炎症活动期的敏感性、特异性、阳性预测值、阴性预测值和准确性。对治疗后11例小肠CD患者行胶囊内镜复查．分析CESI改变与简化CDAI和CRP改变的相关性。结果：不同小肠病变范围的简化CDAI和CRP相比差异无统计学意义（P〉0．05）；小肠CD患者临床特征与CESI无关；简化CDAI和CRP判断胶囊内镜下炎症活动期的敏感性、特异性、阳性预测值、阴性预测值和准确性均较低。治疗后，CESI改变与简化CDAI和CRP改变无相关性（P〉0．05）。结论：简化CDAI和CRP并不能反映胶囊内镜下小肠CD患者病变范围和活动程度：小肠CD的胶囊内镜下黏膜修复情况与临床症状和生化指标的改善不一致．胶囊内镜下病变好转迟滞于简化CDAI和CRP的改善。

Use of CESI, Simplified CDAI and CRP in Evaluating Extent of Lesion and Disease Activity in Small Bowel Crohn's Disease

Background: Small bowel Crohn’s disease(CD) is a chronic relapsing disease.Up to date,data on the value of capsule endoscopy scoring index(CESI),simplified CDAI and CRP in assessing the extent of lesion and disease activity in small bowel CD are limited.Aims: To assess the value of CESI,simplified CDAI and CRP in evaluating the extent of lesion and disease activity in small bowel CD.Methods: Fifty-eight consecutive small bowel CD patients who had undergone capsule endoscopy were enrolled.The relationship between simplified CDAI,CRP and the extent of lesion was assessed,and the correlations between patients’ clinical characteristics and CESI were evaluated.Sensitivity,specificity,positive predictive value and negative predictive value,as well as overall accuracy of simplified CDAI and CRP for predicting disease activity by capsule endoscopy were determined.After treatment,11 patients underwent the second capsule endoscopy.Correlations between changes of CESI and changes of simplified CDAI and CRP were analyzed.Results: No significant difference in simplified CDAI and CRP was found between patients with different extent of lesion in small bowel CD(P>0.05).Clinical characteristics of small bowel CD were not correlated with CESI.Sensitivity,specificity,positive predictive value and negative predictive value,as well as overall accuracy of simplified CDAI and CRP for predicting disease activity by capsule endoscopy were low.After treatment,changes of CESI were not correlated with those of simplified CDAI and CRP(P>0.05).Conclusions: Simplifed CDAI and CRP can not be used as surrogate markers for the assessment of extent of lesion and disease activity in small bowel CD diagnosed by capsule endoscopy.The changes of clinical disease activity and biological markers are poorly correlated with objective capsule endoscopic improvement during small bowel CD therapy.