Deepak Parakkal, Fletcher Joel G, Fidler Jeff L, Barlow John M, Sheedy Shannon P, Kolbe Amy B, Harmsen William S, Loftus Edward V, Hansel Stephanie L, Becker Brenda D, Bruining David H
Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.
Division of Abdominal Imaging, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.
Am J Gastroenterol. 2016 Jul;111(7):997-1006. doi: 10.1038/ajg.2016.177. Epub 2016 May 10.
Crohn's disease (CD) management targets mucosal healing on ileocolonoscopy as a treatment goal. We hypothesized that radiologic response is also associated with better long-term outcomes.
Small bowel CD patients between 1 January 2002 and 31 October 2014 were identified. All patients had pre-therapy computed tomography enterography (CTE)/magnetic resonance enterography (MRE) with follow-up CTE or MRE after 6 months, or 2 CTE/MREs≥6 months apart while on maintenance therapy. Radiologists characterized inflammation in up to five small bowel lesions per patient. At second CTE/MRE, complete responders had all improved lesions, non-responders had worsening or new lesions, and partial responders had other scenarios. CD-related outcomes of corticosteroid usage, hospitalization, and surgery were assessed using Kaplan-Meier survival analysis and multivariable Cox models.
CD patients (n=150), with a median disease duration of 9 years, had 223 inflamed small bowel segments (76 with strictures and 62 with penetrating, non-perianal disease), 49% having ileal distribution. Fifty-five patients (37%) were complete radiologic responders, 39 partial (26%), and 56 non-responders (37%). In multivariable Cox models, complete and partial response decreased risk for steroid usage by over 50% (hazard ratio (HR)s: 0.37 (95% confidence interval (CI), 0.21-0.64); 0.45 (95% CI, 0.26-0.79)), and complete response decreased the risk of subsequent hospitalizations and surgery by over two-thirds (HRs: HR, 0.28 (95% CI, 0.15-0.50); HR, 0.34 (95% CI, 0.18-0.63)).
Radiological response to medical therapy is associated with significant reductions in long-term risk of hospitalization, surgery, or corticosteroid usage among small bowel CD patients. These findings suggest the significance of radiological response as a treatment target.
克罗恩病（CD）的治疗目标是在回结肠镜检查时实现黏膜愈合。我们推测放射学反应也与更好的长期预后相关。
确定2002年1月1日至2014年10月31日期间的小肠CD患者。所有患者在治疗前均进行了计算机断层扫描小肠造影（CTE）/磁共振小肠造影（MRE），并在6个月后进行随访CTE或MRE，或者在维持治疗期间进行两次间隔≥6个月的CTE/MRE。放射科医生对每位患者最多五个小肠病变的炎症情况进行评估。在第二次CTE/MRE检查时，完全缓解者所有病变均有改善，无反应者病变恶化或出现新病变，部分缓解者则为其他情况。使用Kaplan-Meier生存分析和多变量Cox模型评估与CD相关的皮质类固醇使用、住院和手术结局。
CD患者（n = 150），疾病中位病程为9年，有223个小肠炎症节段（76个有狭窄，62个有穿透性非肛周疾病），49%为回肠分布。55例患者（37%）为放射学完全缓解者，39例部分缓解者（26%），56例无反应者（37%）。在多变量Cox模型中，完全缓解和部分缓解使类固醇使用风险降低超过50%（风险比（HR）：0.37（95%置信区间（CI），0.21 - 0.64）；0.45（95% CI，0.26 - 0.79）），完全缓解使后续住院和手术风险降低超过三分之二（HR：HR，0.28（95% CI，0.15 - 0.50）；HR，0.34（95% CI，0.18 - 0.63））。
药物治疗的放射学反应与小肠CD患者住院、手术或使用皮质类固醇的长期风险显著降低相关。这些发现表明放射学反应作为治疗靶点的重要性。
