根据黏膜愈合程度（梅奥0级与1级）评估溃疡性结肠炎复发风险：一项纵向队列研究

Evaluation of the Risk of Relapse in Ulcerative Colitis According to the Degree of Mucosal Healing (Mayo 0 vs 1): A Longitudinal Cohort Study.

作者信息

Barreiro-de Acosta Manuel, Vallejo Nicolau, de la Iglesia Daniel, Uribarri Laura, Bastón Iria, Ferreiro-Iglesias Rocío, Lorenzo Aurelio, Domínguez-Muñoz J Enrique

机构信息

FIENAD, Department of Gastroenterology, Santiago University Clinical Hospital, Santiago de Compostela, Spain

FIENAD, Department of Gastroenterology, Santiago University Clinical Hospital, Santiago de Compostela, Spain.

出版信息

J Crohns Colitis. 2016 Jan;10(1):13-9. doi: 10.1093/ecco-jcc/jjv158. Epub 2015 Sep 7.

DOI:10.1093/ecco-jcc/jjv158

PMID:26351390

Abstract

BACKGROUND AND AIMS

Mucosal healing in ulcerative colitis (UC) has become a common endpoint in most clinical trials and a relevant therapeutic goal in clinical practice. Despite important differences between endoscopic Mayo scores 0 and 1, both scores are considered as mucosal healing in most important trials. The aim of the present study was to evaluate the risk of relapse in UC patients according to the degree of mucosal healing (endoscopic Mayo scores of 0 and 1).

METHODS

A prospective longitudinal cohort study was designed. All UC patients who presented with mucosal healing at colonoscopy were consecutively included. Mucosal healing was defined as an endoscopic Mayo score of 0 or 1. Clinical relapse was defined as the need for therapy to induce remission, any treatment escalation, hospitalization or colectomy. All clinical relapses were evaluated at months 6 and 12 after study entry. Results were subjected to unconditional stepwise logistic and Kaplan-Meier regression analysis.

RESULTS

One hundred and eighty-seven consecutive UC patients (126 [67.3%] with Mayo score 0 and 61 [32.7%] with Mayo score 1) were included. Of patients with Mayo scores 0 and 1, 9.4 and 36.6% respectively presented a relapse during the first 6 months of follow-up (p < 0.001). The only factor independently associated with UC relapses in the multivariate analysis was an endoscopic Mayo score of 1 (odds ratio 6.27, 95% confidence interval 2.73-14.40, p < 0.001).

CONCLUSIONS

Patients with an endoscopic Mayo score of 1 have a higher risk of relapse than those with a score of 0. The concept of mucosal healing should be limited to patients with an endoscopic Mayo score of 0.

摘要

背景与目的

溃疡性结肠炎（UC）的黏膜愈合已成为大多数临床试验的常见终点以及临床实践中的重要治疗目标。尽管内镜下梅奥评分0和1之间存在重要差异，但在大多数重要试验中，这两个评分均被视为黏膜愈合。本研究的目的是根据黏膜愈合程度（内镜下梅奥评分0和1）评估UC患者的复发风险。

方法

设计了一项前瞻性纵向队列研究。连续纳入所有在结肠镜检查时出现黏膜愈合的UC患者。黏膜愈合定义为内镜下梅奥评分为0或1。临床复发定义为需要进行诱导缓解治疗、任何治疗升级、住院或结肠切除术。在研究入组后第6个月和12个月评估所有临床复发情况。结果进行无条件逐步逻辑回归和Kaplan-Meier回归分析。

结果

连续纳入187例UC患者（梅奥评分为0的126例[67.3%]，梅奥评分为1的61例[32.7%]）。梅奥评分0和1的患者中，分别有9.4%和36.6%在随访的前6个月出现复发（p<0.001）。多变量分析中与UC复发独立相关的唯一因素是内镜下梅奥评分为1（比值比6.27，95%置信区间2.73 - 14.40，p<0.001）。