| Background:Crohn’s disease(CD)is a chronic and nonspecific inflammatory disease of the gastrointestinal tract,which is one of the main types of Inflammatory bowel disease(IBD).Remission and relapse accelerate the progression of Crohn’s disease and increase the risk of complications because of the poorly controlling.Achieving mucosal healing(MH)has been shown the significance to reduce the recurrence rate of CD.However,both the assessment of disease activity and mucosal healing require endoscopy which is an invasive examination that increase the risk of bleeding,perforation and other complications and also bring a painful experience for CD patients including high examination costs.Poor compliance of CD patients caused clinical judgment of the patient’s real-time condition difficultly so that the patient’s treatment may not be timely enough.Monitoring the real-time condition of CD at any time is a crucial part during the treatment.Convenient and effective predictive indicators assessing the CD disease activity and MH are needed urgently in clinical practice.Objective:This study explored the relationship between fecal calprotectin(FC),heparin-binding protein(HBP),interleukin-6(IL-6),erythrocyte sediment rate(ESR),C-reactive protein(CRP)and neutrophil-lymphocyte ratio(NLR),lymphocyte-monocyte ratio(LMR),platelet-lymphocyte ratio(PLR),fibrinogen-albumin ratio(FAR)and CD disease activity and MH,evaluated their predictive efficacy and tried to establish a predictive model based on the combined indicators.In order to provide assistance for clinical judgment of the real-time condition of CD patients.Methods:Ninety-five patients included who were hospitalized in the Zhong Da Hospital affiliated to Southeast University from January 2021 to December 2021 were divided by Crohn’s Disease Activity Index(CDAI)and Simple Endoscopic Score for Crohn’s disease(SES-CD)respectively.There are 38 patients in the remission group and 57 patients in the active group according to CDAI,30 patients in mucosal healing group and 65 patients in mucosal non-healing group according SES-CD score.Collect the general data of patients and laboratory tests(FC,HBP,IL-6,ESR,CRP,NLR,LMR,PLR,FAR),compare the differences between the remission group,the active group and the active subgroups,between the mucosal healing group and the mucosal non-healing group.Then use The Speedman correlation analysis to explore the correlation between the indicators and the disease activity and mucosal unhealing.The diagnostic efficacy of various indicators was evaluated by ROC curve and the best predictive joint metrics were derived using a binary logistic regression equation.Results:1.Comparison between remission group,active group and active subgroups.The levels of FC,HBP,IL-6,ESR,CRP,NLR,PLR,and FAR in the active phase group of CD patients were higher than those in the remission group,and the difference was statistically significant(P<0.05).LMR in the active phase group was lower than that in the remission group(P<0.05).The levels of FC,IL-6,ESR and FAR in the mildly active group were higher than those in the remitting group(P<0.05),and the levels of HBP,CRP,NLR,LMR and PLR in the mildly active group were not statistically significant compared with the remission group(P>0.05).The levels of FC,HBP,IL-6,ESR,CRP,NLR,PLR and FAR in the moderate to severe activity group were higher than those in the remission group,and the differences between the two groups were statistically significant(P<0.05),and the LMR in the moderate and severe activity group was reduced compared with the remission group,and the difference was statistically significant(P<0.05).FC,HBP,IL-6,and CRP were higher in the moderate to severe activity group compared with the mildly active group,and the difference was statistically significant(P<0.05)FC,HBP,IL-6,ESR,CRP,NLR,PLR,FAR were positively correlated with CD activity(P<0.05),and LMR was negatively correlated with CD disease activity severity(P<0.05).2.Evaluation of clinical activity.Differentiate between CD disease remission and activity: the AUC of FC is 0.884,the truncation value is 93.80% sensitivity and 73.70% specificity at 40.82ug/g,the AUC of IL-6 is0.860,and the truncation value is 83.80% sensitivity and 81.80% specificity at 6.38;FAR’s AUC is0.880,and the truncation value is 84.20% sensitivity and 23.70% specificity at 0.08;HBP,ESR,CRP,NLR,The AUC of the PLR to assess CD disease activity was 0.793,0.751,0.725,0.701,and0.756,respectively.The combination of the best combined indicators was FC+FAR+IL-6,and the maximum AUC value was 0.959,the sensitivity was 86.00%,and the specificity was 92.10% in distinguishing the remission and activity phases of CD patients.3.Comparison between mucosal healing group and mucosal non-healing group.The levels of FC,HBP,IL-6,ESR,CRP,NLR,PLR and FAR in mucosal healing group were higher than the mucosal healing group,LMR in mucosal healing group was lower than that in mucosal non-healing group.The difference was statistically significant(P<0.05).FC,HBP,IL-6,ESR,CRP,NLR,PLR,FAR were positively correlated with mucosal unhealing(P<0.05),and LMR was negatively correlated(P<0.05).4.Evaluation of mucosal non-healing.Distinguish between mucosal healing and non-healing: the AUC of FC was 0.928,the sensitivity and specificity of assessing mucosal non-healing at 45.83ug/g was 87.50% and 84.20%;the AUC of HBP was 0.859,the sensitivity of 75.00% and specificity of 84.20% at 12.50 ng/ml.The AUC of IL-6 was 0.839,the Cut-off value was 7.60pg/ml with the sensitivity of 55% and the specificity of 94.70%.The AUC of FAR was 0.841,the Cut-off value was 0.10 with the sensitivity of 57.50% and specificity of 94.70% for distinguishing mucosal non-healing.The AUC of ESR,CRP,NLR and PLR was 0.688,0.703,0.724 and 0.730 respectively.The best combination of these indicators was FC+FAR+NLR,and the AUC was 0.929,the sensitivity of 87.70% and specificity of86.70%.Conclusion:1.The levels of FC,HBP,IL-6,ESR,CRP,NLR,PLR,FAR in active CD patients were all higher than that in remission group,LMR level was lower than that in the remission group.2.The levels of FC,HBP,IL-6,ESR,CRP,NLR,PLR,FAR in mucosal non-healing group were higher than that in mucosal healing group,and the level of LMR is lower than that in mucosal healing group.3.FC、HBP、IL-6 and FAR are effective for assessing CD activity and mucosal non-healing.Combined FC+FAR+IL-6 was more predictive effective in assessing CD disease activity than each individual indicator. |
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