克罗恩病患者接受肿瘤坏死因子α抗体（抗TNF）治疗后磁共振小肠造影的变化：与SES-CD及临床生物学标志物的相关性
Magnetic resonance enterography changes after antibody to tumor necrosis factor (anti-TNF) alpha therapy in Crohn's disease: correlation with SES-CD and clinical-biological markers.
作者信息
Stoppino Luca Pio, Della Valle Nicola, Rizzi Stefania, Cleopazzo Elsa, Centola Annarita, Iamele Donatello, Bristogiannis Christos, Stoppino Giuseppe, Vinci Roberta, Macarini Luca
机构信息
Division of Diagnostic Imaging, Department of Surgical Sciences, University of Foggia, Viale Luigi Pinto n.1, Foggia, 71122, Italy.
Division of Gastroenterology, Department of Surgical Sciences, University of Foggia, Viale Luigi Pinto n.1, Foggia, 71122, Italy.
出版信息
BMC Med Imaging. 2016 May 5;16(1):37. doi: 10.1186/s12880-016-0139-7.
BACKGROUND
In recent years, the use of MRI in patients with Crohn's disease (CD) has increased. However, few data are available on how MRI parameters of active disease change during treatment with anti-TNF and whether these changes correspond to symptoms, serum biomarkers, or endoscopic appearance. The aim of this study was to determine the changes over time in MRI parameters during treatment with anti-TNF in patients with CD, and to verify the correlation between MRI score, endoscopic appearance and clinical-biological markers.
METHODS
We performed a prospective single centre study of 27 patients with active CD (18 males and 9 females; median age of 27,4 ys; age range, 19-49). All patients underwent ileocolonoscopy and MRI at baseline and 26 weeks after anti-TNF therapy. Endoscopic severity was graded according to the Simple Endoscopic Score for Crohn's Disease (SES-CD) and Magnetic Resonance Index of Activity (MaRIA) was calculated. Patients underwent clinical evaluation (CDAI) and the C-reactive protein (CRP) level was measured. The associations between variables were assessed with Pearson's bivariate correlation analysis.
RESULTS
A total of 135 intestinal segments were studied. The median patient age was 27,4 years, 67 % were male and the mean disease duration was 6,1 years. For induction of remission, 18 patients were treated with infliximab and 9 with adalimumab. The mean SES-CD and MaRIA scores significantly changed at week 26 (SES-CD: 14,7 ± 8,9 at baseline vs. 4,4 ± 4,6 at 26 weeks - p < 0.001; MaRIA: 41,1 ± 14,8 at baseline vs. 32,8 ± 11,7 at 26 weeks - p < 0.001). Also the CDAI and serum levels of CRP decreased significantly following treatment (p < 0.001). The overall MaRIA correlated with endoscopic score and with clinical activity (CDAI) both at baseline and at week 26 (p < 0.05). The correlation between overall MaRIA and CRP was significant only at week 26 (p < 0.001).
CONCLUSIONS
The MaRIA has a good correlation with SES-CD, a high accuracy for prediction of endoscopic mucosal healing and is a reliable indicator to monitor the use of TNF antagonists in patients with CD.
背景
近年来，磁共振成像（MRI）在克罗恩病（CD）患者中的应用有所增加。然而，关于抗TNF治疗期间活动性疾病的MRI参数如何变化以及这些变化是否与症状、血清生物标志物或内镜表现相符的数据很少。本研究的目的是确定CD患者在抗TNF治疗期间MRI参数随时间的变化，并验证MRI评分、内镜表现与临床生物学标志物之间的相关性。
方法
我们对27例活动性CD患者（18例男性和9例女性；中位年龄27.4岁；年龄范围19 - 49岁）进行了一项前瞻性单中心研究。所有患者在基线时以及抗TNF治疗26周后均接受了回结肠镜检查和MRI检查。根据克罗恩病简易内镜评分（SES - CD）对内镜严重程度进行分级，并计算磁共振活动指数（MaRIA）。患者接受临床评估（CDAI）并测量C反应蛋白（CRP）水平。使用Pearson双变量相关分析评估变量之间的关联。
结果
共研究了135个肠段。患者中位年龄为27.4岁，67%为男性，平均病程为6.1年。为诱导缓解，18例患者接受英夫利昔单抗治疗，9例接受阿达木单抗治疗。在第26周时，平均SES - CD和MaRIA评分有显著变化（SES - CD：基线时为14.7±8.9，26周时为4.4±4.6 - p < 0.001；MaRIA：基线时为41.1±14.8，26周时为32.8±11.7 - p < 0.001）。治疗后CDAI和血清CRP水平也显著下降（p < 0.001）。总体MaRIA在基线和第26周时均与内镜评分和临床活动（CDAI）相关（p < 0.05）。总体MaRIA与CRP之间的相关性仅在第26周时显著（p < 0.001）。
结论
MaRIA与SES - CD具有良好的相关性，对内镜黏膜愈合的预测具有较高的准确性，是监测CD患者使用TNF拮抗剂的可靠指标。
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