Department of Digestive Medicine, Hospital Universitario Dr. Peset, University of Valencia, Gaspar Aguilar 90, 46017, Valencia, Spain.
Department of Diagnostic Radiology, Hospital Universitario Dr. Peset, Gaspar Aguilar 90, 46017, Valencia, Spain.
Dig Dis Sci. 2019 Sep;64(9):2600-2606. doi: 10.1007/s10620-019-05567-w. Epub 2019 Mar 14.
To assess the clinical benefits of transmural healing (TH) shown on intestinal ultrasound (IUS) after treatment with tumor necrosis factor-alpha antibodies (anti-TNF) in patients with Crohn's disease.
This prospective study included consecutively 36 patients who underwent IUS in the week prior to start anti-TNF treatment, at 12 weeks, and 1 year after starting treatment. The clinical response to treatment was assessed using the Crohn's disease activity index and C-reactive protein (CRP) values. TH was defined as the normalization of bowel wall thickness on IUS. Treated patients were considered to have a good outcome if none of the following situations presented: need to reintroduce corticosteroids or intensify maintenance therapy and/or need for surgery.
After the induction regimen, 29 patients (80.6%) achieved clinical remission, and serum CRP values returned to normal in 20 patients (55.6%). In the IUS at 12 weeks, treatment induced a statistically significant reduction in the wall thickness (p < 0.001) and color Doppler grade (p < 0.001), as well as resolution of complications in 66.7% of patients (p < 0.03). IUS after 1 year of biological therapy showed TH in 14/33 patients (42.4%). During the follow-up (median 48.5 months), 23 of the 33 (69.7%) patients in remission or response after induction therapy presented a good outcome. Sonographic TH was significantly related with better outcomes, with only 1/14 patients having a poor outcome compared to 9/19 without TH (OR 11.7, 95% CI 1.2-108.2 p = 0.01, Chi-squared test).
Patients who achieve TH on IUS with biological treatment have better clinical outcomes.
评估在克罗恩病患者中使用肿瘤坏死因子-α 抗体（抗 TNF）治疗后肠超声（IUS）显示的透壁愈合（TH）的临床获益。
这项前瞻性研究纳入了 36 例连续患者，他们在开始抗 TNF 治疗前一周、治疗 12 周和治疗开始后 1 年均接受了 IUS。使用克罗恩病活动指数和 C 反应蛋白（CRP）值评估治疗的临床反应。TH 定义为 IUS 上肠壁厚度的正常化。如果没有出现以下任何情况，则认为接受治疗的患者有良好的结局：需要重新引入皮质类固醇或加强维持治疗和/或需要手术。
在诱导治疗后，29 例患者（80.6%）达到临床缓解，20 例患者（55.6%）血清 CRP 值恢复正常。在 12 周的 IUS 时，治疗导致壁厚度（p<0.001）和彩色多普勒分级（p<0.001）的统计学显著降低，并且 66.7%的患者（p<0.03）并发症得到解决。在 1 年的生物治疗后 IUS 显示 14/33 例患者（42.4%）的 TH。在随访期间（中位数 48.5 个月），诱导治疗后缓解或有反应的 33 例患者中有 23 例（69.7%）有良好的结局。超声 TH 与更好的结局显著相关，仅有 1/14 例患者（11.7，95%CI 1.2-108.2，p=0.01，卡方检验）有不良结局，而 19 例无 TH 的患者中有 9 例（OR）。
在接受生物治疗的患者中，IUS 上出现 TH 的患者具有更好的临床结局。
