Theede Klaus, Kiszka-Kanowitz Marianne, Nordgaard-Lassen Inge, Mertz Nielsen Anette
Gastrounit, Medical Division, Copenhagen University Hospital Hvidovre, Denmark
Gastrounit, Medical Division, Copenhagen University Hospital Hvidovre, Denmark.
J Crohns Colitis. 2015 Aug;9(8):625-32. doi: 10.1093/ecco-jcc/jjv081. Epub 2015 May 8.
Health-related quality of life [HRQoL] is impaired in ulcerative colitis and is correlated to clinical disease activity. The recent shift towards more objective treatment goals like mucosal healing generates a need for evaluating the association between endoscopic disease activity, mucosal healing and HRQoL.
In this cross-sectional study, patients with either active or inactive ulcerative colitis underwent sigmoidoscopy. Clinical disease activity was assessed by the Simple Clinical Colitis Activity Index [SCCAI], endoscopic inflammation by the Mayo Endoscopic Subscore [MES], and HRQoL by the Short Inflammatory Bowel Disease Questionnaire [SIBDQ] and Short Health Scale [SHS].
A total of 110 patients, 71% with active disease, had a median SCCAI score of 3 and a median MES score of 1. Patients in clinical remission had a mean SIBDQ of 60 and SHS of 6. HRQoL decreased significantly with increasing clinical (SIBDQ [χ(2) = 61.8, p < 0.0001] and SHS [χ(2) = 63.4, p < 0.0001]) and endoscopic disease activity (SIBDQ [χ(2) = 33.1, p < 0.0001] and SHS [χ(2) = 40.3, p < 0.0001]). Mucosal healing was associated with a higher HRQoL than active inflammation (59/46, p < 0.0001 [SIBDQ] and 7/20, p < 0.0001 [SHS]). Decreased HRQoL was observed with more extensive disease. Linear regression revealed strong association between SIBDQ and SHS.
Not only clinical disease activity but also endoscopic inflammation and disease extent were associated with decreased HRQoL. Patients with mucosal healing had significant higher HRQoL, emphasising the importance of this treatment goal. Both SHS and SIBDQ are easy to use and to implement, and were strongly correlated.
溃疡性结肠炎患者的健康相关生活质量（HRQoL）受损，且与临床疾病活动相关。近期治疗目标转向诸如黏膜愈合等更客观的目标，这就需要评估内镜下疾病活动、黏膜愈合与HRQoL之间的关联。
在这项横断面研究中，活动性或非活动性溃疡性结肠炎患者接受了乙状结肠镜检查。通过简单临床结肠炎活动指数（SCCAI）评估临床疾病活动，通过梅奥内镜子评分（MES）评估内镜下炎症，通过简短炎症性肠病问卷（SIBDQ）和简短健康量表（SHS）评估HRQoL。
总共110例患者，71%患有活动性疾病，SCCAI中位数为3，MES中位数为1。临床缓解的患者SIBDQ平均分为60，SHS平均分为6。HRQoL随着临床（SIBDQ [χ(2)=61.8，p<0.0001]和SHS [χ(2)=63.4，p<0.0001]）及内镜下疾病活动（SIBDQ [χ(2)=33.1，p<0.0001]和SHS [χ(2)=40.3，p<0.0001]）的增加而显著降低。与活动性炎症相比，黏膜愈合与更高的HRQoL相关（59/46，p<0.0001 [SIBDQ]和7/20，p<0.0001 [SHS]）。疾病范围越广，HRQoL越低。线性回归显示SIBDQ与SHS之间存在强关联。
不仅临床疾病活动，而且内镜下炎症和疾病范围均与HRQoL降低相关。黏膜愈合的患者HRQoL显著更高，强调了这一治疗目标的重要性。SHS和SIBDQ均易于使用和实施，且相关性很强。
