Serological Markers In Predicting Prognosis Of Intestinal Obstruction In Stricture Type Crohn's Disease

Background and Objective:Crohn,s disease(CD)is an autoimmune disease characterized by transmural inflammation of digestive tract.According to its disease behavior,it can be divided into non-strictured and non-penetrating type(B1),structuring type(B2),penetrating type(B3)and perianal lesions(P).Crohn's disease has a high incidence of complications,including intestinal obstruction,intestinal perforation and abdominal abscess.Crohn's disease has a high incidence of complications,including intestinal obstruction,intestinal perforation and abdominal abscess_Stenosed Crohn's disease is the most common type,of which intestinal obstruction is the most common complication.Intestinal obstruction can be caused by either active inflammation,which can be relieved with medical treatment,or by fibrosis and adhesion,which requires endoscopic treatment or surgery.Surgery is the way to completely solve the intestinal stenosis,but the trauma of surgery and the high postoperative complications and recurrence rate make the patients have a greater psychological burden and economic burden,often in the failure of drug treatment or even life risk when the surgery is considered,thus delaying the best time for surgery.In the case of incomplete intestinal obstruction,colonoscopy or double-balloon enteroscopy may not be able to enter the narrow intestinal cavity for further evaluation of the disease,and capsule endoscopy is expensive and has the risk of incarceration.Therefore,the significance of this study is to evaluate the disease activity of crohn's disease with non surgical and non-invasive serological methods and predict whether patients with CD incomplete ileus can be relieved by medical treatment and avoid surgery in the short term.Based on the above research background,this study to investigate the serum neutrophil count(NEU),lymphocyte count(LYM),albumin(ALB),C-reactive protein(CRP),platelet count(PLT),and serology composite index PLT/LYM,NEU/LYM,CRP/ALB,prognostic nutritional index(PNI)and crohn's disease prognosis of incomplete intestinal obstruction in the relationship between the disease activity and prognosis,and evaluate the inspection efficiency,in order to find more accurate assessment of disease activity and predict ileus ease serological markers,to guide clinical.Meterial and methods:Patients diagnosed with stenosis crohn's disease in our hospital from January 2008 to December 2018 were retrospectively summarized.The diagnostic criteria were strictly based on the 2012 consensus on the diagnosis and treatment of inflammatory bowel disease,and patients with incomplete intestinal obstruction were screened out.Patients with other infectious diseases,tuberculosis,tumors,severe liver,kidney,heart,lung,blood diseases and other autoimmune diseases were excluded.All the enrolled patients had 1-year enteroscopy and clinical follow-up data(including laboratory examination,general condition and medication follow-up of the patients),and were divided into the remission group and the non-remission group according to clinical outcomes(in this study,remission refers to endoscopic access to intestinal stenosis within 1 year after treatment).Through the contrast analysis of general situation,the serological examination(neutrophil count(NEU),lymphocyte count(LYM),albumin(propagated),C-reactive protein(CRP),platelet count(PLT),PLT/LYM,NEU/LYM,CRP/propagated,nutritional index(PNI)and prognosis CDAI score,look for differences between the two groups,and then screening factors associated with binary classification Logistic regression analysis,to find the related factors influencing the ease,according to the ROC curve to find the best predictive value.Results:1.60 patients met the inclusion and exclusion criteria and were included in this study.Among them,38 patients with incomplete intestinal obstruction did not achieve remission within 1 year after drug treatment(30 males and 8 females),and 22 patients achieved remission(14 males and 8 females).There were no significant differences in gender composition,body mass index,CDAI score,lesion site and symptoms between the remission group and the non-remission group.The mean age of onset in the remission group was lower than that in the non-remission group(P =0.041).The proportion of patients receiving infliximab within 1 year was higher in the remission group than in the non-remission group(P = 0· 014).The ileocecal valve type in the remission group was higher than that in the non-remission group,and the intestinal type was lower than that in the non-remission group(P?0.029).2.Among the laboratory examination indexes,the serological indexes ALB and PNI measured during the obstruction were higher in the remission group than in the non-remission group.The NEU/LYM remission group was lower than the non-remission group.In addition9 CRP,NLR and CRP/ALB were significantly positively correlated with CDAI scores,while ALB,PNI and CDAI scores were significantly negatively correlated(all P<0.05).In the study of the obstruction site,all the included serological index values had nothing to do with the obstruction site(P>0.05),and the proportion of small intestine and colon obstruction in the group without remission was higher than that in the remission group.Prognostic nutrition index(PNI)is a protective factor that does not relieve after 1 year of treatment,and coliform obstruction and colonic obstruction are risk factors that do not alleviate after obstruction.Among them,the probability of no remission was 0.894 times for every 1 unit increase in PNI.Nonremission was 9.54 times and 7.09 times higher than ileocecal obstruction,respectively.In the multivariate regression analysis,the logistic regression equation model that predicted no relief within 1 year after the treatment of incomplete intestinal obstruction was obtained,Logit(p)=4.802-0.112×PNI+2.256×(coliform)+(0 935×(coliform).In terms of prediction efficiency,the equation obtained by PNI combined with the obstruction site had the highest prediction efficiency.When P>2.52,the sensitivity and specificity of predicting non-remission of obstruction were 89.5%and 40.9%respectively.When NLR was 30.89,the sensitivity and specificity of predicting non-remission of obstruction were 94.79%and 14.6%respectively.Conclusion:1.Prognostic nutritional index(PNI),NLR and the obstruction site have clinical reference value in the prediction and evaluation of no remission of stenosis crohn's disease incomplete intestinal obstruction within 1 year after drug treatment,among which PNI combined with the obstruction site has the highest predictive efficacy.2.The model equation of PNI combined obstruction was Logit(p)=4.802-0.112xPNI+2.256x(coliform obstruction)+0.935x(coliform obstruction),in which p>2.52 could predict no remission after obstruction.3.ALB,CRP,PLR,NLR,CRP/ALB,PNI were correlated with Best CDAI score.