Division of Gastroenterology and Hepatology, Department of Internal Medicine.
Center for Diagnostic and Therapeutic Endoscopy, Keio University School of Medicine, Tokyo, Japan.
Inflamm Bowel Dis. 2019 Mar 14;25(4):782-788. doi: 10.1093/ibd/izy300.
Mucosal healing (MH) is proposed as a therapeutic target for ulcerative colitis (UC). Recent studies have indicated that the rate of clinical relapse in patients with a Mayo endoscopic score (MES) of 1 is higher than that of patients with an MES of 0. However, no study has yet investigated whether therapeutic intervention prevents clinical relapse in patients with an MES of 1.
Patients with UC with an MES of 1 and partial Mayo score ≤2 were included in this study. All patients were followed from first colonoscopy (CS) until follow-up CS. Differences in the rate of clinical relapse (requiring additional treatment for UC) or endoscopic exacerbation (MES ≥2 and proximal extension) were compared between the therapeutic intervention (immediately after first CS) group and the nontherapeutic intervention group; risk factors for relapse were also assessed.
Among 1523 patients with UC who underwent CS between 2013 and 2016, 220 patients were included in this study. The rate of clinical relapse (P = 0.005) and endoscopic exacerbation (P = 0.11) in patients with therapeutic intervention was lower than that in patients without therapeutic intervention. Multivariable analysis indicated that absence of therapeutic intervention (P = 0.001 for clinical relapse, P = 0.050 for endoscopic exacerbation) and a higher Ulcerative Colitis Endoscopic Index of Severity vascular pattern score immediately after first CS (P = 0.021 for clinical relapse, P = 0.019 for endoscopic exacerbation) were risk factors for both clinical relapse and endoscopic exacerbation.
Therapeutic intervention for patients with UC with an MES of 1 might prevent disease relapse.
黏膜愈合（MH）被提议作为溃疡性结肠炎（UC）的治疗靶点。最近的研究表明， Mayo 内镜评分（MES）为 1 的患者的临床复发率高于 MES 为 0 的患者。然而，尚无研究探讨治疗干预是否可以预防 MES 为 1 的患者的临床复发。
本研究纳入了 MES 为 1 且部分 Mayo 评分≤2 的 UC 患者。所有患者均从首次结肠镜检查（CS）开始随访至随访 CS。比较治疗干预（首次 CS 后立即）组与非治疗干预组之间临床复发（需要额外治疗 UC）或内镜加重（MES≥2 和近端延伸）的发生率差异；还评估了复发的危险因素。
在 2013 年至 2016 年间接受 CS 的 1523 例 UC 患者中，有 220 例患者纳入本研究。治疗干预组患者的临床复发率（P=0.005）和内镜加重率（P=0.11）均低于非治疗干预组。多变量分析表明，无治疗干预（临床复发 P=0.001，内镜加重 P=0.050）和首次 CS 后更高的溃疡性结肠炎内镜严重程度血管模式评分（临床复发 P=0.021，内镜加重 P=0.019）是临床复发和内镜加重的危险因素。
对 MES 为 1 的 UC 患者进行治疗干预可能预防疾病复发。
