Mao Ren, Qiu Yun, Chen Bai-Li, Zhang Sheng-Hong, Feng Rui, He Yao, Zeng Zhi-Rong, Ben-Horin Shomron, Chen Min-Hu
Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China.
Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China, and IBD Service, Department of Gastroenterology, Sheba Medical Center and Sackler School of Medicine, Tel-Aviv University, Tel HaShomer, Israel.
Therap Adv Gastroenterol. 2017 Jun;10(6):453-463. doi: 10.1177/1756283X17698089. Epub 2017 Mar 28.
Mucosal healing (MH), the proposed treat to target in Crohn's disease (CD), is associated with improved disease outcomes. There are still scant data on factors associated with achieving MH in clinical practice. We evaluated the probability of achieving MH and identified factors predictive of subsequent MH in patients with CD.
This was a retrospective, observational cohort study. A total of 272 patients with CD with serial endoscopy assessment and subsequent therapeutic management were reviewed. The primary outcome was MH. The cumulative incidence of MH and endoscopic improvement was estimated using the Kaplan-Meier method. Factors independently associated with MH were identified using the Cox proportional hazards model.
Of the 272 patients, 126 (46.32%) achieved MH after a median follow-up period of 33 months (interquartile range: 27-38 months). Factors independently associated with MH by multivariate analysis were time between endoscopic procedures within 26 weeks (hazard ratio [HR]: 1.56; 95% confidence interval [CI]: 1.05-3.39), adjustment of medical therapy when MH was not achieved (HR: 2.07; 95% CI: 1.26-2.33), prior enteric fistula (HR: 0.22; 95% CI: 0.06-0.91), perianal disease at CD diagnosis (HR: 0.58; 95% CI: 0.35-0.95), and C-reactive protein normalization within 12 weeks (HR: 3.23; 95% CI: 1.82-5.88). Similar factors have also been identified for endoscopic improvement.
Performing serial endoscopic procedures at a 26-week interval and subsequent adjustment in medical treatment are helpful in achieving MH. Endoscopic monitoring plays an important role in the treating to target of CD.
黏膜愈合（MH）是克罗恩病（CD）中提议的治疗目标，与改善疾病结局相关。在临床实践中，关于与实现MH相关因素的数据仍然很少。我们评估了实现MH的概率，并确定了CD患者后续MH的预测因素。
这是一项回顾性观察队列研究。共纳入272例接受系列内镜评估及后续治疗管理的CD患者。主要结局为MH。采用Kaplan-Meier法估计MH和内镜改善的累积发生率。使用Cox比例风险模型确定与MH独立相关的因素。
272例患者中，126例（46.32%）在中位随访33个月（四分位间距：27 - 38个月）后实现MH。多因素分析显示，与MH独立相关的因素包括内镜检查间隔时间在26周内（风险比[HR]：1.56；95%置信区间[CI]：1.05 - 3.39）、未实现MH时调整药物治疗（HR：2.07；95%CI：1.26 - 2.33）、既往肠瘘（HR：0.二十、95%CI：0.06 - 0.91）、CD诊断时存在肛周疾病（HR：0.58；95%CI：0.35 - 0.95）以及12周内C反应蛋白正常化（HR：3.23；95%CI：十八、82 - 5.88）。对于内镜改善也发现了类似因素。
每26周进行系列内镜检查并随后调整药物治疗有助于实现MH。内镜监测在CD的达标治疗中起重要作用。
