Stallmach Andreas, Nickel Luisa, Lehmann Thomas, Bokemeyer Bernd, Bürger Martin, Hüppe Dietrich, Kruis Wolfgang, Nikolaus Susanna, Preiss Jan C, Sturm Andreas, Teich Niels, Schmidt Carsten
Andreas Stallmach, Luisa Nickel, Martin Bürger, Carsten Schmidt, Klinik für Innere Medizin IV, Universitätsklinikum Jena, Jena 07747, Germany.
World J Gastroenterol. 2014 Sep 21;20(35):12574-80. doi: 10.3748/wjg.v20.i35.12574.
To detect high risk patients with a progressive disease course of ulcerative colitis (UC) requiring immunosuppressive therapy (IT).
A retrospective, multicenter analysis of 262 UC patients from eight German tertiary inflammatory bowel disease centres was performed. Patients were divided into two groups depending on the patients need to initiate immunosuppressive therapy in the disease course. A comparison between the two groups was made with regard to demographics, clinical and laboratory parameters obtained within three months after UC diagnosis and the response to first medical therapy. Using this data, a prognostic model was established to predict the individual patients probability of requiring an immunosuppressive therapy.
In 104 (39.7%) out of 262 patients, UC therapy required an immunosuppressive treatment. Patients in this group were significantly younger at time of diagnosis (HR = 0.981 ± 0.014 per year, P = 0.009), and required significantly more often a hospitalisation (HR = 2.5 ± 1.0, P < 0.001) and a systemic corticosteroid therapy at disease onset (HR = 2.4 ± 0.8, P < 0.001), respectively. Response to steroid treatment was significantly different between the two groups of patients (HR = 5.2 ± 3.9 to 50.8 ± 35.6 compared to no steroids, P = 0.016 to P < 0.001). Furthermore, in the IT group an extended disease (HR = 3.5 ± 2.4 to 6.1 ± 4.0 compared to proctitis, P = 0.007 to P = 0.001), anemia (HR = 2.2 ± 0.8, P < 0.001), thrombocytosis (HR = 1.9 ± 1.8, P = 0.009), elevated C-reactive protein (CRP) (HR = 2.1 ± 0.9, P < 0.001), and extraintestinal manifestations in the course of disease (HR = 2.6 ± 1.1, P = 0.004) were observed. Six simple clinical items were used to establish a prognostic model to predict the individual risk requiring an IT. This probability ranges from less than 2% up to 100% after 5 years. Using this, the necessity of an immunosuppressive therapy can be predicted in 60% of patients. Our model can determine the need for an immunosuppressive drug therapy or if a "watch and wait" approach is reasonable already early in the treatment course of UC.
Using six simple clinical parameters, we can estimate the patients individual risk of developing a progressive disease course.
检测溃疡性结肠炎（UC）病程呈进展性且需要免疫抑制治疗（IT）的高危患者。
对来自德国八个三级炎症性肠病中心的262例UC患者进行回顾性多中心分析。根据患者在病程中是否需要启动免疫抑制治疗将患者分为两组。比较两组患者的人口统计学、UC诊断后三个月内获得的临床和实验室参数以及对初始药物治疗的反应。利用这些数据建立一个预测模型，以预测个体患者需要免疫抑制治疗的概率。
262例患者中有104例（39.7%）需要免疫抑制治疗。该组患者诊断时年龄显著更小（每年HR = 0.981 ± 0.014，P = 0.009），且分别更常需要住院治疗（HR = 2.5 ± 1.0，P < 0.001）和在疾病发作时接受全身糖皮质激素治疗（HR = 2.4 ± 0.8，P < 0.001）。两组患者对类固醇治疗的反应存在显著差异（与未使用类固醇相比，HR = 5.2 ± 3.9至50.8 ± 35.6，P = 0.016至P < 0.001）。此外，在免疫抑制治疗组中，观察到疾病范围扩大（与直肠炎相比，HR = 3.5 ± 2.4至6.1 ± 4.0，P = 0.007至P = 0.001）、贫血（HR = 2.2 ± 0.8，P < 0.001）、血小板增多症（HR = 1.9 ± 1.8，P = 0.009）、C反应蛋白（CRP）升高（HR = 2.1 ± 0.9，P < 0.001）以及病程中出现肠外表现（HR = 2.6 ± 1.1，P = 0.004）。使用六个简单的临床指标建立了一个预测模型，以预测个体需要免疫抑制治疗的风险。5年后该概率范围从不到2%到100%。利用此模型，60%的患者可以预测免疫抑制治疗的必要性。我们的模型可以在UC治疗过程早期就确定是否需要免疫抑制药物治疗或“观察等待”方法是否合理。
使用六个简单的临床参数，我们可以估计患者发生进展性病程的个体风险。
