Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford, UK.
Gut. 2012 Apr;61(4):535-42. doi: 10.1136/gutjnl-2011-300486. Epub 2011 Oct 13.
Variability in endoscopic assessment necessitates rigorous investigation of descriptors for scoring severity of ulcerative colitis (UC).
To evaluate variation in the overall endoscopic assessment of severity, the intra- and interindividual variation of descriptive terms and to create an Ulcerative Colitis Endoscopic Index of Severity which could be validated.
A two-phase study used a library of 670 video sigmoidoscopies from patients with Mayo Clinic scores 0-11, supplemented by 10 videos from five people without UC and five hospitalised patients with acute severe UC. In phase 1, each of 10 investigators viewed 16/24 videos to assess agreement on the Baron score with a central reader and agreed definitions of 10 endoscopic descriptors. In phase 2, each of 30 different investigators rated 25/60 different videos for the descriptors and assessed overall severity on a 0-100 visual analogue scale. κ Statistics tested inter- and intraobserver variability for each descriptor. A general linear mixed regression model based on logit link and β distribution of variance was used to predict overall endoscopic severity from descriptors.
There was 76% agreement for 'severe', but 27% agreement for 'normal' appearances between phase I investigators and the central reader. In phase 2, weighted κ values ranged from 0.34 to 0.65 and 0.30 to 0.45 within and between observers for the 10 descriptors. The final model incorporated vascular pattern, (normal/patchy/complete obliteration) bleeding (none/mucosal/luminal mild/luminal moderate or severe), erosions and ulcers (none/erosions/superficial/deep), each with precise definitions, which explained 90% of the variance (pR(2), Akaike Information Criterion) in the overall assessment of endoscopic severity, predictions varying from 4 to 93 on a 100-point scale (from normal to worst endoscopic severity).
The Ulcerative Colitis Endoscopic Index of Severity accurately predicts overall assessment of endoscopic severity of UC. Validity and responsiveness need further testing before it can be applied as an outcome measure in clinical trials or clinical practice.
内镜评估的变异性需要对溃疡性结肠炎（UC）严重程度的评分描述符进行严格的研究。
评估总体内镜严重程度评估的变异性、描述符的个体内和个体间变异，并创建一个溃疡性结肠炎内镜严重程度指数，可以对其进行验证。
这项两阶段研究使用了来自梅奥诊所评分 0-11 的患者的 670 段视频乙状结肠镜检查的资料库，补充了 10 段来自 5 名无 UC 患者和 5 名因急性重度 UC 住院的患者的视频。在第 1 阶段，10 名研究人员中的每一位观看 16/24 段视频，与中心读者评估 Baron 评分的一致性，并就 10 个内镜描述符达成一致定义。在第 2 阶段，30 名不同的研究人员中的每一位对 25/60 个不同的视频进行了描述符评估，并对 0-100 视觉模拟量表进行了总体严重程度评估。κ 统计检验了每个描述符的观察者内和观察者间的变异性。基于对数链接和方差β分布的广义线性混合回归模型用于从描述符预测总体内镜严重程度。
第 1 阶段的研究人员与中心读者之间对于“严重”的判断有 76%的一致性，但对于“正常”表现的判断只有 27%的一致性。在第 2 阶段，观察者内和观察者间的加权 κ 值范围分别为 0.34 至 0.65 和 0.30 至 0.45，用于 10 个描述符。最终模型纳入了血管模式（正常/斑片状/完全闭塞）、出血（无/黏膜/腔轻度/腔中度或重度）和糜烂和溃疡（无/糜烂/浅表/深部），每个描述符都有明确的定义，解释了内镜严重程度总体评估中 90%的方差（pR²，Akaike 信息准则），预测值在 100 分制上从 4 到 93 分（从正常到最差内镜严重程度）。
溃疡性结肠炎内镜严重程度指数能够准确预测 UC 的内镜严重程度总体评估。在将其作为临床试验或临床实践中的结局测量之前，需要进一步验证其有效性和反应性。
