Marchal Bressenot A, Riddell R H, Boulagnon-Rombi C, Reinisch W, Danese S, Schreiber S, Peyrin-Biroulet L
Department of Pathology, University Hospital of Reims, Reims, France.
Deparment of Pathology and Laboratory Medicine, Mt Sinai Hospital, Toronto, ON, Canada.
Aliment Pharmacol Ther. 2015 Oct;42(8):957-67. doi: 10.1111/apt.13375. Epub 2015 Aug 24.
In patients with ulcerative colitis (UC), mucosal healing has emerged as a major therapeutic goal, and is usually assessed endoscopically. Histological healing does not correlate very well with endoscopic mucosal healing in UC and persistent histological inflammation might be a better predictor of future clinical relapse than the endoscopic appearance alone.
To define how histological assessment of disease activity should be best done in UC.
Electronic (PubMed/Embase) and manual search.
At least 18 histological indices to assess disease activity in UC have been described, though none are fully validated. However, histological assessment is increasingly used as a secondary endpoint in clinical trials in UC. After reviewing and discussing existing histological scoring systems for UC activity, we describe features of histological response and define three grades of activity: (i) histological healing - complete resolution of abnormalities; (ii) quiescent disease, - lack of mucosal neutrophils but chronic inflammation may remain; (iii) active disease - presence of neutrophils plus possible epithelial damage. It is recommended that two biopsies are taken from each colonic segment which should include always biopsy of the rectum and the most affected segments. There is to date no agreed preferable scoring system but the Geboes Index is the best validated (kappa for interobserver variation 0.59-0.70).
Histological assessment of disease activity in UC is increasingly used, but needs to be carefully defined.
在溃疡性结肠炎（UC）患者中，黏膜愈合已成为主要治疗目标，通常通过内镜进行评估。在UC中，组织学愈合与内镜下黏膜愈合的相关性不太好，持续的组织学炎症可能比单纯的内镜表现更能预测未来的临床复发。
确定在UC中如何最好地进行疾病活动的组织学评估。
电子（PubMed/Embase）检索和手工检索。
已描述了至少18种用于评估UC疾病活动的组织学指标，尽管没有一个指标得到充分验证。然而，组织学评估在UC临床试验中越来越多地用作次要终点。在回顾和讨论现有的UC活动组织学评分系统后，我们描述了组织学反应的特征并定义了三个活动等级：（i）组织学愈合——异常完全消退；（ii）静止期疾病——缺乏黏膜中性粒细胞，但可能仍存在慢性炎症；（iii）活动期疾病——存在中性粒细胞以及可能的上皮损伤。建议从每个结肠段取两块活检组织，其中应始终包括直肠和受累最严重段的活检。迄今为止，尚无公认的最佳评分系统，但Geboes指数是验证最好的（观察者间变异的kappa值为0.59 - 0.70）。
UC疾病活动的组织学评估使用越来越多，但需要仔细界定。
