Division of Gastroenterology, University of California San Diego, La Jolla, California; Department of Gastroenterology, University Hospital of Rennes, Pontchaillou, France; Inserm U991 University of Rennes 1, Rennes, France.
Division of Gastroenterology, University of California San Diego, La Jolla, California.
Clin Gastroenterol Hepatol. 2014 Jun;12(6):978-85. doi: 10.1016/j.cgh.2013.11.005. Epub 2013 Nov 15.
BACKGROUND & AIMS: Mucosal healing has been proposed as a goal for treatment because it is associated with improved clinical outcomes of patients with Crohn's disease (CD). However, little is known about the feasibility or probability of achieving mucosal healing in clinical practice. We evaluated the feasibility of treating patients to achieve mucosal healing based on endoscopic evaluation (treating to target).
We reviewed the endoscopic outcomes of 67 patients with CD who had lesions detected by endoscopy. Patients underwent 2 to 4 subsequent endoscopic evaluations at the University of California San Diego and were followed up from 2011 through 2012; data were collected on therapies and patient management. The cumulative incidences of mucosal healing and endoscopic improvement were estimated using the Kaplan-Meier method. Factors independently associated with mucosal healing were identified using a Cox proportional hazards model.
After a median follow-up period of 62 weeks, 34 patients (50.7%) had mucosal healing and 41 patients (61.1%) had endoscopic improvement. The cumulative probabilities of mucosal healing were 12.7% and 45.0% at 24 and 52 weeks of treatment, respectively. Factors associated with mucosal healing were as follows: fewer than 26 weeks between endoscopic procedures (hazard ratio, 2.35; 95% confidence interval, 1.15-4.97; P = .035) and adjustment to medical therapy when mucosal healing was not observed (hazard ratio, 4.28; 95% confidence interval, 1.9-11.5; P = .0003).
In an endoscopic study of patients with CD, we found that assessment of endoscopic disease activity and adjustments to medical therapy (treat to target) increase the likelihood of mucosal healing.
黏膜愈合已被提议作为治疗目标，因为它与改善克罗恩病（CD）患者的临床结局相关。然而，在临床实践中实现黏膜愈合的可行性或概率知之甚少。我们评估了根据内镜评估（靶向治疗）治疗患者实现黏膜愈合的可行性。
我们回顾了在加利福尼亚大学圣地亚哥分校接受内镜检查发现病变的 67 例 CD 患者的内镜结果。这些患者在 2011 年至 2012 年期间接受了 2 至 4 次后续内镜评估，并进行了随访；收集了治疗和患者管理方面的数据。使用 Kaplan-Meier 方法估计黏膜愈合和内镜改善的累积发生率。使用 Cox 比例风险模型确定与黏膜愈合独立相关的因素。
中位随访 62 周后，34 例（50.7%）患者黏膜愈合，41 例（61.1%）患者内镜改善。治疗 24 周和 52 周时黏膜愈合的累积概率分别为 12.7%和 45.0%。与黏膜愈合相关的因素如下：内镜检查之间的时间少于 26 周（风险比，2.35；95%置信区间，1.15-4.97；P =.035）和在未观察到黏膜愈合时调整药物治疗（风险比，4.28；95%置信区间，1.9-11.5；P =.0003）。
在一项针对 CD 患者的内镜研究中，我们发现评估内镜疾病活动度和调整药物治疗（靶向治疗）增加了黏膜愈合的可能性。
