Efficacy Of Serological Markers In Monitoring Mucosal Healing And Recurrence In Crohn's Disease

Background and Objective:Crohn's disease(CD),which etiology is unclear,is characterized by chronic and recurrent intestinal ulcer.It divided into two periods in the clinical by the inflammation active or not.Using the Crohn's disease activity index(CDAI),we defined the CDAI<150 as Clinical Remission(CR).And using the Crohn's disase simplified endoscopic score(SES-CD),SES-CD<2 can be defined as mucosal healing(MH).Currently,MH has been proven to significantly reduce the patient's recurrence rate and the need for surgery.However,definition of MH requires colonoscopy for each re-examination.Endoscopy is an invasive examination.And before the examination,bowel preparation is required.The painful experience during the examination is often difficult for the patient to accept during the clinical remission,which resulting in a high recurrence rate.Therefore,a non-invasive method to assess Crohn's disease,which is easier for patients to accept,can not only provide the basis for clinicians to develop treatment programs,but also to avoid too frequent colonoscopy to reduce the suffering of patients.Based on the above research background,this study investigated the relationship between serum albumin(ALB),C-reactive protein(CRP),platelet count(PLT),plasma fibrinogen(Fbg C),PLT/ALB,CRP/ALB and MH,recurrence,and assessment of their efficacy in order to find serological markers that can accurately assess mucosal healing and disease recurrence,increase the patient's follow-up to reduce the recurrence rate of the disease and guide clinical practice.Meterial and methods:1.Patients with Crohn's disease who were treated in our hospital from January 2000 to December 2017 and achieved clinical remission were divided into two groups by achieving MH.Comparing general patient data,serologic data,included albumin(ALB),C-reactive protein(CRP),platelet count(PLT),plasma fibrinogen(Fbg C),and SES-CD scores in two groups.And the ROC curve was used to evaluate the diagnostic efficacy of each serological markers for monitoring mucosal healing.2.Choose the patient like the first part.Patients are divided into two groups by recurrence or not.Comparing general patient data,serologic data,included albumin(ALB),C-reactive protein(CRP),platelet count(PLT),plasma fibrinogen(Fbg C),and SES-CD scores in two groups.And the ROC curve was used to evaluate the diagnostic efficacy of each serological markers for predicting disease relapse.Results:1.75 patients joined our research.32 of them achieved MH(23 males and 9 females),and the other 43 only CR(24 males and 19 females.There are no significant difference in gender and age between group MH and CR.Before the treatment,there are no statistically significant differences in ALB,PLT,Fbg C,CRP/ALB,and PLT/ALB between the two groups.And after the treatment,in group MH,ALB is higher than the group CR,and CRP,PLT,Fbg C,PLT/ALB,CRP/ALB are lower.And ALB,CRP,CRP/ALB,PLT/ALB and SES-CD scores were significantly correlated(P<0.05).The CRP/ALB and CRP values were not related to the locations of the diseae(P>0.05).In the efficacy of serological markers in monitoring MH,when the serological indicators were used in combination,the correct index was higher than that of a single serological indicator,and The CRP/ALB had the highest correct index in diagnosis of MH.When CRP/ALB<0.147,the sensitivity of the diagnosis of MH is 79.1%,specificity is 71.9%.The diagnostic performance of the remaining indicators is as followsL:ALB(sensitivity 84.4%,specificity 55.8%),CRP(sensitivity 81.4%,specificity 68.7%),Fbg C(sensitivity 76.7%,specificity 68.7%),PLT(sensitivity 76.7%,specificity 56.2%),PLT/ALB(sensitivity 69.8%,specificity 75.0%).2.In the prediction of disease recurrence,there are 27 patients relapsed during the follow-up period in the non-MH group,with a recurrence rate of 62.79%,and 12 patients in the MH group recurred with a recurrence rate of 37.50%.The recurrence rate in the MH group was lower than that in the non-MH group(P<0.05).Compared with the non-recurrent group,ALB was lower in the relapse group,and CRP,PLT,PLT/ALB,and CRP/ALB were higher(P<0.05).In terms of predictive efficacy analysis,when CRP/ALB>0.33,the prediction efficacy is highest(sensitivity 53.8%,specificity 80.6%),and the remaining three indicators predict efficacy as follows:ALB(sensitivity 53.8%,specificity 69.2%),CRP(sensitivity 48.7%,specificity 80.6%),PLT(sensitivity 59.0%,specificity 72.2%),PLT/ALB(sensitivity 46.2%,specificity 86.1%).Conclusion:1.This study selected the simplest serological markers that could be used in primary hospitals and confirmed that PLT/ALB,CRP/ALB,ALB,CRP,and PLT had the effect of judging whether patients were MH and predicting disease recurrence.CRP/ALB has the highest diagnostic efficiency,when the CRP/ALB>0.147,we need to think about the reproduction of intestinal inflammation.When CRP/ALB>0.33,the patient will have a higher recurrence rate.The combined use of serologic markers seems superior to single use of serological markers.CRP/ALB,CRP can evaluate the patients for each location of the disease,and reduce the system offset caused by different lesions...