Department of Gastroenterology, Qilu Hospital, Shandong University, Jinan, China.
Am J Gastroenterol. 2010 Jun;105(6):1391-6. doi: 10.1038/ajg.2009.664. Epub 2009 Nov 24.
The assessment of inflammation activity in ulcerative colitis (UC) includes endoscopy and histology. Confocal laser endomicroscopy (CLE) combines real-time endoscopy and histology. This study was aimed at evaluating the application of CLE in the assessment of inflammation activity in UC.
In total, 73 consecutive patients with UC who visited Qilu Hospital for colonoscopy surveillance underwent CLE. Inflammation activity was first assessed by the colonoscopy Baron score, then by CLE with a 4-grade classification of crypt architecture, as well as by analysis of microvascular alterations and fluorescein leakage. Targeted biopsy samples were taken for histological analysis. Stored CLE images were subjected to post-CLE objective assessment.
Both assessment of crypt architecture and fluorescein leakage with CLE showed good correlations with histological results (Spearman's rho, both P<0.001). CLE seemed to be more accurate than conventional white-light endoscopy for evaluating macroscopical normal mucosa. More than half of the patients with normal mucosa seen on conventional white-light endoscopy showed acute inflammation on histology, whereas no patients with normal mucosa or with chronic inflammation seen on CLE showed acute inflammation on histology. Assessment of microvascular alterations by CLE showed good correlation with histological findings (P<0.001). On post-CLE objective assessment, subjective architectural classifications were supported by the number of crypts per image (P<0.001) but not fluorescein leakage results by gray scale (P=0.194).
CLE is reliable for real-time assessment of inflammation activity in UC. Crypt architecture, microvascular alterations, and fluorescein leakage are promising markers in CLE evaluation.
溃疡性结肠炎（UC）的炎症活动评估包括内镜和组织学检查。共聚焦激光内镜（CLE）将实时内镜和组织学检查结合在一起。本研究旨在评估 CLE 在 UC 炎症活动评估中的应用。
共纳入 73 例因结肠镜筛查而就诊齐鲁医院的 UC 患者，均接受 CLE 检查。首先通过结肠镜下 Baron 评分评估炎症活动，然后通过 CLE 对隐窝结构进行 4 级分类，并分析微血管改变和荧光素渗漏。对靶向活检样本进行组织学分析。对存储的 CLE 图像进行 CLE 后客观评估。
CLE 评估隐窝结构和荧光素渗漏与组织学结果均具有良好相关性（Spearman 相关系数，均 P<0.001）。CLE 评估宏观正常黏膜的准确性似乎优于传统白光内镜。在传统白光内镜下观察到正常黏膜的患者中，超过一半在组织学上表现为急性炎症，而在 CLE 下观察到正常黏膜或慢性炎症的患者在组织学上均无急性炎症。CLE 评估微血管改变与组织学发现具有良好相关性（P<0.001）。在 CLE 后客观评估中，主观结构分类与图像中隐窝数量相关（P<0.001），但与灰度荧光素渗漏结果无关（P=0.194）。
CLE 可实时可靠地评估 UC 的炎症活动。隐窝结构、微血管改变和荧光素渗漏是 CLE 评估中很有前途的标志物。
