Gastrointestinal Unit, Department of Systems Medicine, University of Rome "Tor Vergata," Rome, Italy.
Interdepartmental Center of Biostatistics and Bioinformatics, University of Rome "Tor Vergata," Rome, Italy.
Clin Gastroenterol Hepatol. 2014 Dec;12(12):2071-7. doi: 10.1016/j.cgh.2014.04.036. Epub 2014 May 6.
BACKGROUND & AIMS: Therapeutic antibodies against tumor necrosis factor α (anti-TNF) are effective in patients with Crohn's disease (CD). Mucosal healing is a surrogate marker of efficacy, but little is known about the effects of anti-TNF agents on structural damage in the intestine. Small-intestine contrast ultrasonography (SICUS) is a valuable tool for assessing CD lesions. A new sonographic quantitative index (the sonographic lesion index for CD [SLIC]) was developed to quantify changes in CD lesions detected by SICUS. We explored whether the SLIC can be used to monitor transmural bowel damage in CD patients during anti-TNF therapy.
We performed a prospective study of 29 patients with ileal or ileocolonic CD treated with anti-TNF agents; patients underwent SICUS before and after scheduled induction and maintenance therapy. To determine whether changes that can be detected by SICUS occur independently of anti-TNF therapy, 7 patients with ileal CD treated with mesalamine were enrolled as controls. A clinical response was defined as steroid-free remission, with CD activity index scores less than 150.
We observed significant improvements in SLIC scores and subscores after induction and maintenance therapy with anti-TNFs, compared with before therapy. SLIC scores and subscores and index classes were improved significantly in patients with vs without clinical responses. Controls had no improvements in terms of CD activity index or SLIC scores, or index classes.
Sonographic assessment using the quantitative index SLIC can be used to monitor changes in transmural bowel damage during anti-TNF therapy for CD.
针对肿瘤坏死因子α（anti-TNF）的治疗性抗体在克罗恩病（CD）患者中具有疗效。黏膜愈合是疗效的替代标志物，但对于抗 TNF 药物对肠道结构损伤的影响知之甚少。小肠对比超声（SICUS）是评估 CD 病变的有价值工具。已经开发出一种新的超声定量指数（CD 的超声病变指数 [SLIC]），用于量化 SICUS 检测到的 CD 病变的变化。我们探讨了 SLIC 是否可用于监测 CD 患者在抗 TNF 治疗期间的透壁肠损伤。
我们对 29 例接受抗 TNF 药物治疗的回肠或回结肠 CD 患者进行了前瞻性研究；患者在计划的诱导和维持治疗前后接受了 SICUS 检查。为了确定 SICUS 可检测到的变化是否独立于抗 TNF 治疗，我们招募了 7 例接受美沙拉嗪治疗的回肠 CD 患者作为对照。临床应答定义为无类固醇缓解，CD 活动指数评分<150。
与治疗前相比，我们观察到抗 TNF 诱导和维持治疗后 SLIC 评分和亚评分显著改善。与无临床应答的患者相比，有临床应答的患者 SLIC 评分和亚评分以及指数分类显著改善。对照患者在 CD 活动指数或 SLIC 评分或指数分类方面没有改善。
使用定量指数 SLIC 的超声评估可用于监测 CD 患者在抗 TNF 治疗期间透壁肠损伤的变化。
