采用先进技术评估内镜愈合情况可反映溃疡性结肠炎的组织学愈合情况。
Assessment of Endoscopic Healing by Using Advanced Technologies Reflects Histological Healing in Ulcerative Colitis.
机构信息
Institute of Translational Medicine, Institute of Immunology and Immunotherapy and NIHR Birmingham Biomedical Research Centre, University Hospitals NHS Foundation Trust and University of Birmingham, Birmingham, UK.
Division of Gastroenterology and Hepatology, University of Calgary, Canada.
出版信息
J Crohns Colitis. 2020 Sep 16;14(9):1282-1289. doi: 10.1093/ecco-jcc/jjaa056.
BACKGROUND
Several studies have reported that ulcerative colitis [UC] patients with endoscopic mucosal healing may still have histological inflammation. We investigated the relationship between mucosal healing defined by modified PICaSSO [Paddington International Virtual ChromoendoScopy ScOre], Mayo Endoscopic Score [MES] and probe-based confocal laser endomicroscopy [pCLE] with histological indices in UC.
METHODS
A prospective study enrolling 82 UC patients [male 66%] was conducted. High-definition colonoscopy was performed to evaluate the activity of the disease with MES assessed with High-Definition MES [HD-MES] and modified PICaSSO and targeted biopsies were taken; pCLE was then performed. Receiver operating characteristic [ROC] curves were plotted to determine the best thresholds for modified PICaSSO and pCLE scores that predicted histological healing according to the Robarts Histopathology Index [RHI] and ECAP 'Extension, Chronicity, Activity, Plus' histology score.
RESULTS
A modified PICaSSO of ≤ 4 predicted histological healing at RHI ≤ 3, with sensitivity, specificity, accuracy and area under the ROC curve [AUROC] of 89.8%, 95.7%, 91.5% and 95.9% respectively. The sensitivity, specificity, accuracy and AUROC of HD-MES to predict histological healing by RHI were 81.4%, 95.7%, 85.4% and 92.1%, respectively. A pCLE ≤ 10 predicted histological healing with sensitivity of 94.9%, specificity of 91.3%, accuracy of 93.9% and AUROC of 96.5%. An ECAP of ≤ 10 was predicted by modified PICaSSO ≤ 4 with accuracy of 91.5% and AUROC of 95.9%.
CONCLUSION
Histological healing by RHI and ECAP is accurately predicted by HD-MES and modified virtual electronic chromoendoscopy PICaSSO, endoscopic score; and the use of pCLE did not improve the accuracy any further.
背景
几项研究报告称，内镜下黏膜愈合的溃疡性结肠炎[UC]患者仍可能存在组织学炎症。我们研究了改良 PICaSSO[帕丁顿国际虚拟染色内镜评分]、Mayo 内镜评分[MES]和基于探头的共聚焦激光内 镜检查[pCLE]与 UC 组织学指标之间的关系。
方法
进行了一项前瞻性研究，共纳入 82 例 UC 患者[男性占 66%]。采用高清晰度结肠镜检查评估疾病活动度，采用高清 MES[HD-MES]和改良 PICaSSO 评估 MES，并进行靶向活检；然后进行 pCLE。绘制受试者工作特征[ROC]曲线，以确定改良 PICaSSO 和 pCLE 评分的最佳阈值，根据 Robarts 组织学指数[RHI]和 ECAP“延伸、慢性、活动、外加”组织学评分预测组织学愈合。
结果
改良 PICaSSO≤4 预测 RHI≤3 的组织学愈合，其敏感性、特异性、准确性和 ROC 曲线下面积[AUROC]分别为 89.8%、95.7%、91.5%和 95.9%。HD-MES 预测 RHI 组织学愈合的敏感性、特异性、准确性和 AUROC 分别为 81.4%、95.7%、85.4%和 92.1%。pCLE≤10 预测组织学愈合的敏感性为 94.9%，特异性为 91.3%，准确性为 93.9%，AUROC 为 96.5%。改良 PICaSSO≤4 预测 ECAP≤10 的准确性为 91.5%，AUROC 为 95.9%。
结论
HD-MES 和改良虚拟电子染色内镜 PICaSSO、内镜评分准确预测 RHI 和 ECAP 的组织学愈合，而 pCLE 的使用并不能进一步提高准确性。
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