The Clinical Value And Consistency Of Classic CDAI?SES-CD And CRP?ESRin Evaluating Activities Of CD Disease

Background and Objective Crohn's disease(CD)is a kind of unknown etiology of chronic non-specific inflammatory bowel disease.After a clear diagnosis of CD,it needs to be assessed as early as possible,in order to facilitate a comprehensive assessment of the disease,ideal prognosis and accurate options of treatment.Crohn's disease activity index(CDAI)is the main measure for evaluating the activity of CD disease in clinics;simple endoscopic score for Crohn's disease(SES-CD)is the most commonly used scoring system under the endoscopy at home and abroad,and ERP as well as ESR are laboratory indexes.The classic CDAI index is more subjective,but tends to underestimate the degree of inflammation of the disease.The biggest shortcoming is that the natural course of the treatment cannot induce and maintain clinical remission of CD change,so the clinical application is very limited.Due to the complexity of the evaluation method of CDEIS(the Crohn's disease endoscopic index of severity)as well as the limitations of the clinical application,studies have shown that SES-CD is highly correlated with CDEIS and SES-CD is a simplified version of the commonly used CDEIS,but the SES-CD evaluation method is still complex.At the same time,CRP and ESR are significant indexes for evaluating CDEIS due to their easy operation,good repetition,obvious outcome,and wide application.At present,the study on the clinical value and consistency of SES-CD and CDAI in evaluation of CD activities is very few,the rating criteria have their limitations,and still needs to be further improved.In conclusion,the CD treatment targets from symptoms to the depth of mucosa healing has been greatly developed and perfected,which is conducive to better monitor the disease,reduce the rate of surgery as well as hospitalization,and improve the quality of patients' lives.If the three parties in assessing the consistency of CD activity is good,we can choose any one which is much more applicable in clinics;if poor,we will have the necessity to develop a more reliable and feasible evaluation system.These patients with CD in this study mainly underwent endoscopic and clinical SES-CD classic CDAI,which aims to explore the necessity of existence of non classical CDAI and their clinical value as well as the consistency in the evaluation of the activity of CD by using CRP and ESR,and the results of this study will provide a more reliable evidence in evaluating the activity of CD.Methods74 cases of CD patients were screened who were admitted to the Department of Digestive Medicine in Shanghai Tenth People's Hospital from October 2014 to March 2016.When not understanding the clinical manifestations and pathological severity of patients,at least two digestive endoscopy physicians from the hospital score the patients independently(SES-CD)according to endoscopic results in order to avoid bias and influence the objectivity of scoring.If they disagree with each other on endoscopic scoring,they should turn to the senior doctor for consultation and reach agreement on the final score.Another physician who did not participate in the endoscopic evaluation should score CDAI on the basis of consulting the medical records and assess the patient's clinical activity.Patients were drawn blood for testing CRP and ESR while undergoing endoscopy examination in the same day.Finally,data were analyzed by using statistical software system to calculate CDAI in judging the sensitivity,specificity,positive predictive,negative predictive,and accuracy during the period of inflammation period under endoscopy assessing the correlation among SES-CD,CDAI,as well as Laboratory Indexes(CRP,ESR)and their clinical significance.Results1.The correlation between CDAI and SES-CD by using linear analysis is found,but not significant(R=0.378,P=0.001).2.Making a comparison between CDAI and CRP,SES-CD and CRP through the linear analysis method,CDAI,SES-CD and CRP have correlation,and the correlation between SES-CD and CRP(R=0.412,P=0.000)is higher than that of CDAI and CRP(R=0.390,P=0.001),but the correlations were not significant.3.Making a comparison between CDAI and ESR,SES-CD and ESR respectively by using the linear analysis method,the correlations between CDAI,SES-CD and ESR were found and the correlation between SES-CD and ESR,(R=0.431,P=0.001)is higher than that of CDAI and ESR(R=0.410,P=0.002),but the correlations were not significant too.4.Based on CDAI in assessing different severities and the correlation between it and SES by using the rank transform analysis method(not patients' CDAI>450),the correlation between different severity of CDAI(remission,mild,moderate)with SES-CD scoring was analyzed and found that the score of the patient in remission compared to patients in mild and moderate is different,the correlation between SES score(P=0.000)of the patients in remission with patients in moderate higher than the correlation between SES score(P=0.026)of patients in remission and in patients with mild,but SES score(P=0.190)between patients with mild and moderate is not significant.Conclusion The study found that there is a correlation among CDAI,SES-CD,CRP and ESR,but the correlation was not significant,each evaluation method can not be replaced by any other kinds of evaluation methods,which indicates that the severity of CD staging can not be used solely as a comprehensive one.