Center for Inflammatory Bowel Disease, Beth Israel Deaconess Medical Center & Harvard Medical School, Boston, Massachusetts, USA.
Department of Pathology, Beth Israel Deaconess Medical Center & Harvard Medical School, Boston, Massachusetts, USA.
Am J Gastroenterol. 2016 May;111(5):685-90. doi: 10.1038/ajg.2016.50. Epub 2016 Mar 15.
Objective evidence of inflammation has been associated with the risk of relapse in patients with ulcerative colitis (UC) who are in clinical remission. We compared endoscopic and histologic grades for their ability to predict clinical relapse in this patient population.
Patients with UC in clinical remission were prospectively enrolled into an observational cohort. Baseline endoscopic scores (Mayo) and histological (Geboes) grades and blood markers were collected. All subjects were followed for 12 months and relapse determined using clinical indices.
A total of 179 subjects were enrolled into the study and followed for 12 months. Clinical relapse occurred in 23%; 5% were hospitalized, and 2% underwent colectomy. In univariate analysis, the baseline Mayo endoscopy score and the Geboes histology grade were significantly associated with the later development of clinical relapse (P<0.001 for both), but only the histology grade remained significant in a multivariate model (P=0.006). The relative risk of clinical relapse was 3.5 (95% CI 1.9-6.4, P<0.0001) in subjects whose baseline Geboes grade was ≥3.1. The area under the curve was 0.73 for the Geboes histology grade to identify subjects at risk of future clinical relapse. Of the patients in clinical, endoscopic, and histological remission at baseline (n=82), only 7% had a clinical relapse over the subsequent 12 months.
Histology grade has the strongest association with the risk of clinical relapse in patients with UC who are in clinical remission. Consideration should be given to including this end point in evaluating therapy for UC.
有炎症的客观证据与溃疡性结肠炎（UC）处于临床缓解期的患者复发的风险相关。我们比较了内镜和组织学分级，以评估它们在该患者人群中预测临床复发的能力。
前瞻性地招募处于临床缓解期的 UC 患者进入观察队列。收集基线内镜评分（Mayo）和组织学（Geboes）分级以及血液标志物。所有患者随访 12 个月，采用临床指标确定复发。
共有 179 例患者入组并随访 12 个月。23%的患者发生临床复发，5%住院，2%行结肠切除术。单因素分析显示，基线 Mayo 内镜评分和 Geboes 组织学分级与随后发生临床复发显著相关（两者 P<0.001），但在多变量模型中仅组织学分级有统计学意义（P=0.006）。基线 Geboes 分级≥3.1 的患者临床复发的相对风险为 3.5（95%CI 1.9-6.4，P<0.0001）。Geboes 组织学分级预测未来临床复发的受试者曲线下面积为 0.73。在基线时处于临床、内镜和组织学缓解的 82 例患者中，仅 7%在随后的 12 个月内发生临床复发。
组织学分级与 UC 患者临床缓解期复发风险的关联最强。在评估 UC 的治疗时，应考虑将该终点纳入其中。
