溃疡性结肠炎临床缓解患者内镜下炎症的预测因素。
Predictors of endoscopic inflammation in patients with ulcerative colitis in clinical remission.
机构信息
Center for Inflammatory Bowel Disease, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
出版信息
Inflamm Bowel Dis. 2013 Mar-Apr;19(4):779-84. doi: 10.1097/MIB.0b013e3182802b0e.
BACKGROUND
Patients with ulcerative colitis (UC) who are in clinical remission may still have underlying endoscopic inflammation, which is associated with inferior clinical outcomes. The goal of this study was to determine the prevalence of active endoscopic disease, and factors associated with it, in patients with UC who are in clinical remission.
METHODS
Prospective observational study in a single center. Patients with UC in clinical remission (by Simple Clinical Colitis Activity Index) were enrolled prospectively at the time of surveillance colonoscopy. Disease phenotype, endoscopic activity (Mayo subscore), and histologic score (Geboes) were recorded, and blood was drawn for peripheral blood biomarkers.
RESULTS
Overall, 149 patients in clinical remission were prospectively enrolled in this cohort; 81% had been in clinical remission for >6 months, and 86% were currently prescribed maintenance medications. At endoscopy, 45% of patients in clinical remission had any endoscopic inflammation (Mayo endoscopy subscore >0), and 13% had scores >1. In a multivariate model, variables independently associated with a Mayo endoscopic score >1 were remission for <6 months (P = 0.001), white blood count (P = 0.01), and C-reactive protein level (P = 0.009). A model combining these 3 variables had a sensitivity of 94% and a specificity of 73% for predicting moderate-to-severe endoscopic activity in patients in clinical remission (area under the curve, 0.86). In an unselected subgroup of patients who had peripheral blood mononuclear cell messenger RNA profiling, GATA3 messenger RNA levels were significantly higher in patients with endoscopic activity.
CONCLUSIONS
Duration of clinical remission, white blood count, and C-reactive protein level can predict the probability of ongoing endoscopic activity, despite clinical remission in patients with UC. These parameters could be used to identify patients who require intensification of treatment to achieve mucosal healing.
背景
处于临床缓解期的溃疡性结肠炎（UC）患者可能仍存在潜在的内镜下炎症，这与较差的临床结局相关。本研究旨在确定处于临床缓解期的 UC 患者中活跃的内镜疾病的患病率，以及与该疾病相关的因素。
方法
在一家单中心进行前瞻性观察性研究。在监测性结肠镜检查时，前瞻性纳入处于临床缓解期（根据简单临床结肠炎活动指数）的 UC 患者。记录疾病表型、内镜活动（Mayo 亚评分）和组织学评分（Geboes），并采集外周血生物标志物。
结果
本队列共前瞻性纳入 149 例处于临床缓解期的患者；81%的患者缓解时间>6 个月，86%的患者目前正在服用维持药物。内镜下，45%的临床缓解期患者存在任何内镜炎症（Mayo 内镜评分>0），13%的患者评分>1。多变量模型显示，与 Mayo 内镜评分>1 独立相关的变量包括缓解时间<6 个月（P=0.001）、白细胞计数（P=0.01）和 C 反应蛋白水平（P=0.009）。这 3 个变量的组合模型对预测临床缓解期患者的中重度内镜活动具有 94%的敏感性和 73%的特异性（曲线下面积，0.86）。在未选择的外周血单核细胞信使 RNA 谱分析患者亚组中，内镜活动患者的 GATA3 信使 RNA 水平显著升高。
结论
尽管 UC 患者处于临床缓解期，但缓解持续时间、白细胞计数和 C 反应蛋白水平可预测持续内镜活动的概率。这些参数可用于识别需要强化治疗以实现黏膜愈合的患者。
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