Predictors of depression in youth with Crohn disease.
Predictors of depression in youth with Crohn disease.
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DOI：
10.1097/mpg.0000000000000277
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发表时间：
2014-05
影响因子：
2.9
通讯作者：
Szigethy EM
中科院分区：
文献类型：
--
作者：
Clark JG;Srinath AI;Youk AO;Kirshner MA;McCarthy FN;Keljo DJ;Bousvaros A;DeMaso DR;Szigethy EM
该研究的目的是确定英夫利西单抗的使用和其他潜在的预测因子是否与克罗恩病（CD）儿童患者抑郁症的患病率和严重程度降低相关。作为一项多中心随机对照试验的一部分，连续招募了550名（n = 550）9至17岁的经活检证实的CD青年。在550例患者中，499例患者符合研究标准并被纳入分析。在招募时，每个受试者和父母完成了儿童抑郁量表（CDI）。儿童或父母CDI评分≥ 12表示有临床意义的抑郁症状（CSDS）。将儿童和父母CDI评分相加以形成总CDI（CDIT）。收集英夫利西单抗使用、人口统计学信息、类固醇使用、实验室检查值和儿童克罗恩病活动指数（PCDAI）作为抑郁症的潜在预测因素。构建单变量回归模型以确定预测因子、CSDS和CDIT之间的关系。建立逐步多元回归模型预测英夫利西单抗使用与抑郁症之间的关系，同时控制其他抑郁症预测因子。调整多重比较后，英夫利西单抗的使用与CSDS和CDIT比例降低无关。CSDS和CDIT与PCDAI、红细胞沉降率和类固醇剂量呈正相关（P<0.01），与社会经济地位（SES）呈负相关（P<0.001）。在多变量模型中，PCDAI和SES是抑郁症的最强预测因子。疾病活动度和SES是克罗恩病青年抑郁症的重要预测因子。
The aim of the study was to determine whether infliximab use and other potential predictors are associated with decreased prevalence and severity of depression in pediatric patients with Crohn disease (CD). A total of 550 (n = 550) youth ages 9 to 17 years with biopsy-confirmed CD were consecutively recruited as part of a multicenter randomized controlled trial. Out of the 550, 499 patients met study criteria and were included in the analysis. At recruitment, each subject and a parent completed the Children’s Depression Inventory (CDI). A child or parent CDI score ≥ 12 was used to denote clinically significant depressive symptoms (CSDS). Child and parent CDI scores were summed to form total CDI (CDIT). Infliximab use, demographic information, steroid use, laboratory values, and Pediatric Crohn’s Disease Activity Index (PCDAI) were collected as the potential predictors of depression. Univariate regression models were constructed to determine the relations among predictors, CSDS, and CDIT. Stepwise multivariate regression models were constructed to predict the relation between infliximab use and depression while controlling for other predictors of depression. Infliximab use was not associated with a decreased proportion of CSDS and CDIT after adjusting for multiple comparisons. CSDS and CDIT were positively associated with PCDAI, erythrocyte sedimentation rate, and steroid dose (P<0.01) and negatively associated with socioeconomic status (SES) (P<0.001). In multivariate models, PCDAI and SES were the strongest predictors of depression. Disease activity and SES are significant predictors of depression in youth with Crohn disease.