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通过胶囊内镜评估小肠黏膜愈合作为克罗恩病患者长期临床缓解的预测指标:一项系统评价和荟萃分析

Small-bowel mucosal healing assessment by capsule endoscopy as a predictor of long-term clinical remission in patients with Crohn's disease: a systematic review and meta-analysis.

作者信息

Niv Yaron

机构信息

Department of Gastroenterology, Rabin Medical Center, Tel Aviv University, Petah Tikva, Israel.

出版信息

Eur J Gastroenterol Hepatol. 2017 Jul;29(7):844-848. doi: 10.1097/MEG.0000000000000881.

Abstract

Capsule endoscopy (CE) may be used for the evaluation and follow-up of patients with Crohn's disease. CE scores correspond to the degree of mucosal inflammation, a major therapeutic target. The aim of this meta-analysis and systematic review was to determine whether mucosal healing assessment by CE may serve as a predictor of clinical remission in patients with Crohn's disease. To identify observational or controlled English-language full-text studies assessing mucosal healing by CE in patients with Crohn's disease up to 30 September 2016, we searched PubMed, Embase, Central, Medline, and Scopus using the key words 'mucosal healing' and 'capsule endoscopy'. A meta-analysis was carried out using 'Comprehensive meta-analysis' software. Pooled odds ratios and 95% confidence intervals were calculated. Five observational studies including 142 patients from five countries fulfilled the inclusion criteria. No publication bias was found by funnel plot. The mucosal healing CE score was found to be significantly associated with improved outcome after a follow-up of 12 weeks to 24 months, with an odds ratio of 11.06 (95% confidence interval: 3.74-32.73, P<0.001). The degree of heterogeneity among the studies was small (Q=2.014, d.f.[Q]=3, P=0.569 and I=0). Endoscopy scores may play a role in the long-term prognostic evaluation of patients with Crohn's disease. Our results may be accepted as proof of concept, but larger studies are needed to corroborate these findings.

摘要

胶囊内镜检查(CE)可用于克罗恩病患者的评估和随访。CE评分与黏膜炎症程度相对应,而黏膜炎症是主要的治疗靶点。本荟萃分析和系统评价的目的是确定通过CE进行的黏膜愈合评估是否可作为克罗恩病患者临床缓解的预测指标。为了识别截至2016年9月30日评估克罗恩病患者通过CE进行黏膜愈合的观察性或对照英文全文研究,我们使用关键词“黏膜愈合”和“胶囊内镜检查”检索了PubMed、Embase、Central、Medline和Scopus。使用“综合荟萃分析”软件进行荟萃分析。计算合并比值比和95%置信区间。五项观察性研究纳入了来自五个国家的142名患者,符合纳入标准。漏斗图未发现发表偏倚。发现黏膜愈合CE评分与随访12周至24个月后的改善结局显著相关,比值比为11.06(95%置信区间:3.74 - 32.73,P<0.001)。研究之间的异质性程度较小(Q = 2.014,d.f.[Q] = 3,P = 0.569且I = 0)。内镜评分可能在克罗恩病患者的长期预后评估中发挥作用。我们的结果可作为概念验证接受,但需要更大规模的研究来证实这些发现。

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