Buda Andrea, Hatem Giorgia, Neumann Helmut, D'Incà Renata, Mescoli Claudia, Piselli Pierluca, Jackson John, Bruno Marco, Sturniolo Giacomo Carlo
Department of Surgical, Gastroenterological and Oncological Sciences, University of Padova, Padova, Italy.
Department of Surgical, Gastroenterological and Oncological Sciences, University of Padova, Padova, Italy.
J Crohns Colitis. 2014 Apr;8(4):304-11. doi: 10.1016/j.crohns.2013.09.005. Epub 2013 Oct 2.
Neoangiogenesis and increased endothelial permeability are observed as results of chronic intestinal inflammation. However, limited data on microvascular and crypt architecture during remission phases is available. The aim of this prospective investigator blinded cohort study was to assess crypt and microvascular architecture and function in ulcerative colitis by probe based confocal laser endomicroscopy; we also evaluated whether these findings may have the potential to predict disease relapse.
19 ulcerative colitis patients in clinical and endoscopic remission and 19 controls were studied. A computer based image processing technique was applied to construct 20 mosaicing image sets from each subject. Remitting patients were sub-grouped into either inactive or quiescent disease according to histology.
Pericrypt fluorescence (p<0.01), crypt diameter (p<0.05) but not intercrypt distance (p=0.07) were significantly increased in ulcerative colitis patients compared to controls. Patients with inactive disease showed a significant increase in fluorescence leakage (median fluorescence (IQR), 3888 (3560-4240) vs. 2696 (2502-3390), p<0.01), crypt diameter (median diameter (IQR), 92.5 (85.5-101) vs. 73 (70-77), p<0.05) and intercrypt distance (median distance (IQR), 82.5 (70.5-91.2) vs. 66 (59.5-73.5), p<0.05) compared to those with quiescent disease. A composite outcome score combining fluorescence leakage and crypt diameter was able to predict a disease flare during a 12 month follow-up period (p<0.01).
In vivo intramucosal changes detected by confocal endomicroscopy in ulcerative colitis remittent patients can predict disease relapse. This observation may have further implications for disease management and medical treatment.
慢性肠道炎症会导致新血管生成和内皮通透性增加。然而，关于缓解期微血管和隐窝结构的数据有限。这项前瞻性研究者设盲队列研究的目的是通过基于探头的共聚焦激光内镜显微镜评估溃疡性结肠炎患者的隐窝和微血管结构及功能；我们还评估了这些发现是否有可能预测疾病复发。
对19例处于临床和内镜缓解期的溃疡性结肠炎患者及19例对照者进行研究。应用基于计算机的图像处理技术，从每个受试者构建20个镶嵌图像集。根据组织学将缓解期患者分为疾病非活动期或静止期亚组。
与对照组相比，溃疡性结肠炎患者的隐窝周围荧光（p<0.01）、隐窝直径（p<0.05）显著增加，但隐窝间距（p=0.07）无显著差异。与疾病静止期患者相比，疾病非活动期患者的荧光渗漏（中位荧光（IQR），3888（3560 - 4240）对2696（2502 - 3390），p<0.01）、隐窝直径（中位直径（IQR），92.5（85.5 - 101）对73（70 - 77），p<0.05）和隐窝间距（中位间距（IQR），82.5（70.5 - 91.2）对66（59.5 - 73.5），p<0.05）显著增加。结合荧光渗漏和隐窝直径的综合结局评分能够预测12个月随访期内的疾病复发（p<0.01）。
共聚焦内镜显微镜检测到的溃疡性结肠炎缓解期患者体内黏膜内变化可预测疾病复发。这一观察结果可能对疾病管理和治疗有进一步的意义。
