临床实践中的黏膜愈合：单中心儿科 IBD 经验。
Mucosal Healing in Clinical Practice: A Single-Center Pediatric IBD Experience.
机构信息
*Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia; †Department of Pediatric Gastroenterology, Children's Healthcare of Atlanta, Atlanta, Georgia; ‡Department of Public Health Sciences, UC Davis Health System, Sacramento, CA; and §Department of Biostatistics and Bioinformatics, Emory University Rollins School of Public Health, Atlanta, Georgia.
出版信息
Inflamm Bowel Dis. 2017 Aug;23(8):1447-1453. doi: 10.1097/MIB.0000000000001176.
BACKGROUND
Mucosal healing (MH) is associated with improved clinical outcomes in patients with Crohn's disease (CD) and ulcerative colitis (UC). MH as a target for treatment has been suggested, although there is little pediatric data. The goal of this study was to evaluate MH in clinical practice in pediatric patients with inflammatory bowel disease in clinical remission.
METHODS
A retrospective review of electronic health record data was performed on all patients with CD or UC who underwent at least 2 colonoscopies from 2010 through 2016. Only patients in clinical remission undergoing a scope for MH were included in our study. The incidence of MH and histologic healing (HH) was analyzed, along with cumulative rates of MH in each group. MH was defined by both physician assessment of MH and an endoscopic score of zero for CD and UC.
RESULTS
A total of 76 patients with CD and 28 patients with UC underwent at least one MH scope while in clinical remission. Of the 76 patients with CD, 51 patients (67%) demonstrated MH by physician assessment, 34 patients (45%) demonstrated MH by a simple endoscopic score for CD of zero, and 35 patients (46%) demonstrated HH. Of the 28 patients with UC, 20 patients (71%) demonstrated MH by physician assessment, 10 patients (36%) demonstrated MH by a Mayo score of zero, and 10 patients (36%) demonstrated HH. Nineteen patients underwent a second MH scope and 11 (58%) demonstrated MH by physician assessment, 7 patients (37%) demonstrated MH by simple endoscopic score for CD or Mayo scores of zero, and 5 patients (26%) demonstrated HH. Of those patients with active disease, 21 of 25 patients with CD underwent escalation of therapy, whereas 8 of 8 patients with UC underwent escalation of therapy. Cumulative rates of MH when defined by physician assessment were 79% (60 of 76 patients) in CD and 79% (22 of 28 patients) in UC.
CONCLUSIONS
MH is feasible in pediatric CD and UC, and rates of cumulative MH in pediatric patients are similar to previously published adult data. In children with inflammatory bowel disease in clinical remission, approximately one-third demonstrate active disease at endoscopy.
背景
黏膜愈合（MH）与克罗恩病（CD）和溃疡性结肠炎（UC）患者的临床改善结果相关。虽然儿科数据较少，但已经提出 MH 作为治疗靶点。本研究的目的是评估处于临床缓解期的儿科炎症性肠病患者的 MH 在临床实践中的情况。
方法
对 2010 年至 2016 年期间接受至少 2 次结肠镜检查的所有 CD 或 UC 患者的电子病历数据进行回顾性分析。仅纳入正在接受 MH 检查且处于临床缓解期的患者。分析 MH 和组织学愈合（HH）的发生率，以及每组 MH 的累积率。MH 通过医生对 MH 的评估和 CD 的内镜评分均为 0 来定义。
结果
共有 76 例 CD 患者和 28 例 UC 患者在临床缓解期接受了至少一次 MH 检查。在 76 例 CD 患者中，51 例（67%）经医生评估显示 MH，34 例（45%）CD 内镜简单评分显示 MH，35 例（46%）HH。在 28 例 UC 患者中，20 例（71%）经医生评估显示 MH，10 例（36%）Mayo 评分显示 MH，10 例（36%）HH。19 例患者接受了第二次 MH 检查，其中 11 例（58%）经医生评估显示 MH，7 例（37%）CD 内镜简单评分或 Mayo 评分显示 MH，5 例（26%）HH。在有活动疾病的患者中，25 例 CD 患者中有 21 例升级了治疗，而 8 例 UC 患者中有 8 例升级了治疗。当 MH 经医生评估时，CD 的累积 MH 率为 79%（76 例患者中的 60 例），UC 为 79%（28 例患者中的 22 例）。
结论
MH 在儿科 CD 和 UC 中是可行的，儿科患者累积 MH 率与先前发表的成人数据相似。在处于临床缓解期的炎症性肠病儿童中，大约三分之一的患者内镜下存在活动疾病。
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