几种血液指标在炎症性肠病初步诊断及活动度评价中的作用

  本文关键词：几种血液指标在炎症性肠病初步诊断及活动度评价中的作用，由笔耕文化传播整理发布。

        目的：(1)观察几种血液指标，包括血红蛋白(HGB)、平均红细胞体积(MCV)、血小板计数(PLT)、红细胞分布宽度(RDW)、血沉(ESR)、超敏C反应蛋白(CRP)、平均血小板容积(MPV)在IBD组和健康对照组、IBD两种亚型(克罗恩病，CD；溃疡性结肠炎，UC)组及IBD亚型不同活动度组间的水平有无差别。(2)评价上述指标在IBD的初步诊断、临床亚型鉴别、疾病活动程度评价中的灵敏度和特异度。(3)采用诊断性meta分析，系统、定量地评价红细胞分布宽度(RDW)在IBD疾病活动度评价中的作用。方法：(1)收集于2008年6月到2012年6月期间在苏州市立医院(北区)消化科住院，年龄为18至65周岁，，长期居住于苏州地区，无IBD家族史，经综合诊断确诊为IBD的患者130例(60例CD，70例UC)，及在该院体检中心进行体检的与IBD患者性别、年龄匹配的健康对照者130例。收集患者的住院资料及患者和健康对照的血液检查结果。(2)分别采用克罗恩病疾病活动度指数(Crohn’s disease activity index, CDAI)和修正的Truelove-Witts指数对CD和UC患者的疾病活动度进行评分。活动期CD定义为CD患者CDAI评分≥150，活动期UC定义修正的Truelove-Witts评分≥11分。为分析比较各血液指标在IBD和健康对照组、CD和UC组、活动期和缓解期CD组、活动期和缓解期UC组间水平(均数或中位数)有无显著差别；采用受试者工作特征曲线(receiver operating curve, ROC)分析上述几种血液指标在IBD的初步诊断、亚型鉴别、活动度评价中的曲线下面积(area under the curve, AUC)、灵敏度、特异度。以上统计用SPSS17.0完成。(3)系统检索Medline、ISI Web of Knowledge、谷歌学术和中国知网中2013年2月1日以前发表的研究RDW评价IBD疾病活动度的文献。采用二元混合效应回归模型计算合并的灵敏度、特异度及ROC曲线下面积值及其95%可信区间。此部分统计分析用STATA12.0统计软件完成。结果：(1)各指标在IBD组和健康对照组间水平都存在显著差异(P＜0.05)。(2) ESR和CRP可较好鉴别IBD组和健康对照组，ROC曲线下面积分别为0.88和0.86，灵敏度/特异度分别为79%/85%(ESR切点9.5mm/h)和82%/79%(CRP切点4.6mg/L)。(3) RDW和MCV可较好区分CD和UC，曲线下面积分别为0.81和0.80，灵敏度/特异度分别为76%/72%(RDW切点13.5)和70%/73%(MCV切点87.9fL)，亚组分析进一进步发现RDW鉴别CD和UC的效果仅限于活动期IBD。(4)关于IBD疾病活动度的评估结果发现，评价CD疾病活动度最好的指标依次是CRP、RDW和ESR，曲线下面积都大于0.80，当CRP取6.5mg/L时，其鉴别活动期和缓解期CD的灵敏度和特异度分别为85%和75%；而几种指标中未发现能较好评估UC活动度的指标，效果最好的RDW，其ROC曲线下面积仅为0.73.(5)诊断性meta分析纳入6项研究，包含996例IBD患者(451例CD，545例UC)。结果显示，RDW可较好区分活动期与缓解期CD，合并的灵敏度、特异度及ROC曲线下面积分别为79%(95%CI,70-85%)、0.78%(95%CI,68-88%)和0.84(95%CI,0.81-0.87)；RDW评价UC活动度有较高特异度(79%)，但灵敏度较低(64%)。结论：CRP和ESR可作为IBD初步诊断、疾病活动度评价(主要是CD活动度评价)的敏感、特异的指标；RDW或可作为IBD临床亚型鉴别和疾病活动度评价(主要是CD活动度评价)的简便、廉价、敏感、特异的新指标。

    Objective:1. To investigate whether there were significant differences in the distribution ofseveral selected blood parameters, including hemoglobin (HGB), mean corpuscularvolume (MCV), platelet count(PLT), red cell distribution width(RDW), erythrocytesedimentation rate (ESR), C-reactive protein (CRP) and mean platelet volume (MPV)between inflammatory bowel disease (IBD) and healthy control groups, or betweenCrohn’s disease (CD) and Ulcerative Colitis (UC) groups, or active and inactive IBDgroups.2. To evaluate the role of these parameters in the initial diagnosis, subtypediscrimination and activity assessment of IBD.3. To assess the role of RDW in the activity assessment of IBD by conducting adiagnostic meta-analysis.Methods：1. One hundred thirty IBD patients (including60CD and70UC) who wereresiding in Suzhou, aged18to65years and had no family history of IBD were enrolled.All patients hospitalized in Department of Gastroenterology of Suzhou MunicipalHospital (North Campus) between June2008and June2012, and were confirmed tohave been suffering from IBD according to comprehensive diagnosis. The patients werematched to130healthy controls who were free of IBD and other gastrointestinaldiseases by age and sex. Hospitalization data for patients and the data of blood test forboth IBD and controls were collected.2. The activity of the disease was assessed using the Crohn’s disease activity index(CDAI) for CD patients and the corrected Truelove-Witts index for UC patients,respectively. Active disease was defined as a CDAS of at least150for CD and a corrected Truelove-Witts index of at least11. The mean or median levels of theparameters between IBD and controls, CD and UC, active and inactive CD, active andinactive UC were respectively evaluated to detect whether there were significantdifferences in the levels of these parameters between groups. Receiver operating curve(ROC) analysis was used to determine the area under the curve (AUC), sensitivity andspecificity of these parameters in distinguishing IBD and controls, CD and UC, andactive and inactive IBD.3. A comprehensive literature search was conducted by use of multiple databasescovering Medline, ISI Web of Knowledge, Google Scholar and CNKI. A bivariatemixed-effects regression model was assigned to calculate the combined sensitivity,specificity and the AUC of RDW in assessing disease activity of IBD.Results:1. There were statistically significant differences in the levels of each parameterbetween IBD and controls (P＜0.05).2. ESR and CRP were each found to be effective in distinguishing IBD andhealthy controls, with an AUC of0.88and0.86, sensitivity of79%and82%, andspecificity of85%and79%, respectively (cut-off value was9.5mm/h for ESR and4.6mg/L for CRP).3. RDW and MCV were each shown to be effective in distinguishing CD andUC, with an AUC of0.81and0.80, sensitivity of76%and70%, and specificity of72%and73%, respectively (cut-off value was13.5for RDW and87.9fL forMCV). Further analyses found that the observed diagnostic value of RDW waslimited in distinguishing active CD and active UC.4. CRP followed by RDW and ESR were effective in the activity assessmentof CD, all with AUCs of over0.80. CRP had a sensitivity and a specificity of85%and75%, respectively, in discrimination between active and inactive CD, whengiven a cut-off value of6.5mg/L; none of the studied blood parameters was shown tobe able to effectively evaluate the activity of UC, with the most effective one (RDW)achieving an AUC of merely0.73.5. Six studies that totaled996IBD patients (451CD and545UC) were included inthe diagnostic meta-analysis. The combined sensitivity and specificity for RDW todetect active patients among CD was79%(95%CI,70-85%) and78%(95%CI， 68-88%), and the combined AUC was0.84(95%CI,0.81-0.87); Whereas RDW wasshown to specifically (79%), but not sensitively (64%) detect active patients among UC.Conclusion:Both CRP and ESR are sensitive and specific in the initial diagnosis and activityassessment of IBD (limited to CD); RDW may serve as a new parameter in blood that issimple, inexpensive, sensitive and specific in the discrimination of subtypes and activityassessment of IBD (limited to CD).

几种血液指标在炎症性肠病初步诊断及活动度评价中的作用

中文摘要4-6Abstract6-8引言10-13第一部分 几种血液指标在炎症性肠病初步诊断及活动度评价中的作用13-25    一、研究对象与方法13-16    二、研究结果与分析16-25第二部分 红细胞分布宽度评价炎症性肠病活动度的 meta 分析25-39    一、研究对象与方法25-26    二、研究结果与分析26-33    三、讨论与结论33-39参考文献39-49综述49-63    参考文献57-63中英文缩写词语对照表63-64硕士研究生期间发表的论文64-66致谢66-67

  本文关键词：几种血液指标在炎症性肠病初步诊断及活动度评价中的作用，由笔耕文化传播整理发布。