Division of Gastroenterology, Department of Medicine, Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada.
Division of Gastroenterology, Department of Medicine, Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada.
Clin Gastroenterol Hepatol. 2019 Feb;17(3):411-418.e3. doi: 10.1016/j.cgh.2018.06.015. Epub 2018 Jun 18.
BACKGROUND & AIMS: We aimed to evaluate the association of the patient-reported outcomes for rectal bleeding and stool frequency among patients with ulcerative colitis (UC) in endoscopic remission.
We performed a systematic review of studies reporting the association of patient-reported outcomes (the patient-reported components of the Mayo score: rectal bleeding and stool frequency) and endoscopic remission (Mayo endoscopic subscore of 0 or 1). We performed a meta-analysis of diagnostic accuracy using the hierarchical bivariate method.
Our meta-analysis consisted of 5 studies comprising 2132 participants. A rectal bleeding subscore of 0 identified patients in endoscopic remission with a pooled sensitivity value of 81% (95% CI, 73%-86%), a specificity value of 68% (95% CI, 61%-75%), a positive likelihood ratio (LR) of 2.5 (95% CI, 2.2-3.0), and a negative LR of 0.28 (95% CI, 0.22-0.37). A stool frequency subscore of 0 identified patients in endoscopic remission with a pooled sensitivity value of 40% (95% CI, 25%-58%), a specificity value of 93% (95% CI, 86%-97%), a positive LR of 6.0 (95% CI, 3.7-9.7), and negative LR of 0.64 (95% CI, 0.50-0.82). A combined rectal bleeding and stool frequency subscore of 0 identified patients in endoscopic remission with a pooled sensitivity value of 36% (95% CI, 22%-54%), a specificity value of 96% (95% CI, 91%-98%), a positive LR or 8.4 (95% CI, 5.5-12.8), and a negative LR or 0.66 (95% CI, 0.53-0.84).
In a meta-analysis of 5 studies, we found that most patients with UC and normal rectal bleeding and stool frequency subscores have attained endoscopic remission. Many patients in endoscopic remission from UC have no rectal bleeding. Normal stool frequency associates with endoscopic remission, but many patients have abnormal stool frequencies despite endoscopic remission. These results should be carefully considered given the high heterogeneity and wide confidence intervals for some outcomes.
我们旨在评估溃疡性结肠炎（UC）患者内镜缓解时直肠出血和粪便频率的患者报告结局之间的关联。
我们对报告患者报告结局（Mayo 评分的患者报告部分：直肠出血和粪便频率）与内镜缓解（Mayo 内镜亚评分 0 或 1）之间关联的研究进行了系统评价。我们使用分层双变量方法对诊断准确性进行了荟萃分析。
我们的荟萃分析包括 5 项研究，共纳入 2132 名参与者。直肠出血亚评分 0 可识别内镜缓解患者，汇总敏感性值为 81%（95%CI，73%-86%），特异性值为 68%（95%CI，61%-75%），阳性似然比（LR）为 2.5（95%CI，2.2-3.0），阴性似然比为 0.28（95%CI，0.22-0.37）。粪便频率亚评分 0 可识别内镜缓解患者，汇总敏感性值为 40%（95%CI，25%-58%），特异性值为 93%（95%CI，86%-97%），阳性 LR 为 6.0（95%CI，3.7-9.7），阴性 LR 为 0.64（95%CI，0.50-0.82）。直肠出血和粪便频率联合亚评分 0 可识别内镜缓解患者，汇总敏感性值为 36%（95%CI，22%-54%），特异性值为 96%（95%CI，91%-98%），阳性 LR 为 8.4（95%CI，5.5-12.8），阴性 LR 为 0.66（95%CI，0.53-0.84）。
在对 5 项研究的荟萃分析中，我们发现大多数 UC 患者的直肠出血和粪便频率亚评分正常，已达到内镜缓解。许多 UC 内镜缓解患者无直肠出血。正常粪便频率与内镜缓解相关，但许多患者尽管内镜缓解仍存在粪便频率异常。鉴于某些结果存在高度异质性和宽置信区间，这些结果应谨慎考虑。
