Parente F, Molteni M, Marino B, Colli A, Ardizzone S, Greco S, Sampietro G, Gallus S
Gastrointestinal Unit, A. Manzoni Hospital, IT-23900 Lecco, Italy.
Dig Dis. 2009;27(3):285-90. doi: 10.1159/000228562. Epub 2009 Sep 24.
Mucosal healing (MH) after short-term medical treatment is being considered as an important step in the therapeutic work-up of inflammatory bowel disorder (IBD) patients due to the potential prognostic role of MH in predicting disease outcome. However, IBD patients are reluctant to be re-endoscoped during follow-up; therefore, there is a need for non-invasive alternative index of MH which can replace endoscopy in clinical practice. We evaluated bowel ultrasound (US) as a surrogate of colonoscopy in a series of consecutive patients with active ulcerative colitis (UC).
83 patients with moderate to severe UC requiring high-dose steroids were initially recruited; endoscopic severity of UC was graded 0-3 according to Baron score, and US severity was also graded 0-3 according to the colonic wall thickening and the presence of vascular signal at power Doppler. 74 patients responsive to steroids and then maintained on 5-ASA compounds were followed up with repeated colonoscopy and bowel US at 3, 9 and 15 months from entry. Concordance between clinical, endoscopic and US scores at various visits was determined by kappa statistics. Multiple unconditional logistic regression models were used to assess the predictivity of Truelove, Baron and US scores measured at 3 and 9 months on the development of a UC relapse (Baron score 2-3) at 15 months.
An inconsistent concordance was found over time between 0 and I Baron scores and Truelove score (weighted kappa between 0.38 and 0.94), with high and consistent concordance between 0 and I Baron scores and US scores (weighted kappa between 0.76 and 0.90). On logistic regression analysis, a moderate/severe Baron score, regardless of their Truelove score, at 3 months was associated with a high risk of endoscopic activity at 15 months (OR 5.2; 95% CI: 1.6-17.6); similarly, patients with severe US scores (2-3) at 3 months had a high risk of severe endoscopic activity at 15 months (OR 9.1; 95% CI: 2.5-33.5).
In expert hands bowel US may be used as a surrogate of colonoscopy in evaluating the response to high-dose steroids in severe forms of UC. US score after 3 months of steroid therapy accurately predicts clinical outcome of disease at 15 months.
短期药物治疗后的黏膜愈合（MH）被视为炎症性肠病（IBD）患者治疗评估中的重要一步，因为MH在预测疾病转归方面具有潜在的预后作用。然而，IBD患者在随访期间不愿接受再次内镜检查；因此，需要一种非侵入性的MH替代指标，以便在临床实践中取代内镜检查。我们在一系列连续的活动性溃疡性结肠炎（UC）患者中评估了肠道超声（US）作为结肠镜检查的替代方法。
最初招募了83例需要大剂量类固醇治疗的中度至重度UC患者；根据Baron评分将UC的内镜严重程度分为0 - 3级，根据结肠壁增厚情况及能量多普勒显示的血管信号将US严重程度也分为0 - 3级。74例对类固醇有反应并随后维持使用5 - ASA化合物的患者在入组后3、9和15个月接受重复结肠镜检查和肠道US检查。通过kappa统计确定不同访视时临床、内镜和US评分之间的一致性。使用多个无条件逻辑回归模型评估在3个月和9个月时测量的Truelove、Baron和US评分对15个月时UC复发（Baron评分2 - 3）发生情况的预测能力。
随着时间推移，0至I级Baron评分与Truelove评分之间存在不一致的一致性（加权kappa在0.38至0.94之间），而0至I级Baron评分与US评分之间存在高度且一致的一致性（加权kappa在0.76至0.90之间）。在逻辑回归分析中，无论其Truelove评分如何，3个月时中度/重度Baron评分与15个月时内镜活动的高风险相关（比值比5.2；95%置信区间：1.6 - 17.6）；同样，3个月时US评分严重（2 - 3级）的患者在15个月时发生严重内镜活动的风险较高（比值比9.1；95%置信区间：2.5 - 33.5）。
在专家手中，肠道超声可作为结肠镜检查的替代方法用于评估重度UC患者对大剂量类固醇的反应。类固醇治疗3个月后的US评分可准确预测15个月时疾病的临床转归。
