INSERM CIC 1401, Service d'hépato-gastroentérologie et oncologie digestive, Centre Medico-chirurgical Magellan, Hôpital Haut-Lévêque, CHU de Bordeaux, Université de Bordeaux, Bordeaux, France.
Institut des Maladies de l'Appareil Digestif, Hépato-Gastroentérologie, Hôtel-Dieu, CHU de Nantes, Nantes, France.
Clin Gastroenterol Hepatol. 2021 Jun;19(6):1180-1188.e4. doi: 10.1016/j.cgh.2020.08.001. Epub 2020 Aug 7.
BACKGROUND/AIMS: Few data on the evolution of endoscopic findings are available in patients with acute severe ulcerative colitis (ASUC). The aim of this study was to describe this evolution in a prospective cohort.
Patients admitted for a steroid-refractory ASUC and included in a randomized trial comparing infliximab and cyclosporine were eligible if they achieved steroid-free clinical remission at day 98. Flexible sigmoidoscopies were performed at baseline, days 7, 42 and 98. Ulcerative colitis endoscopic index of severity (UCEIS) and its sub-scores - vascular pattern, bleeding and ulceration/erosion - were post-hoc calculated. Global endoscopic remission was defined by a UCEIS of 0, and partial endoscopic remission by any UCEIS sub-score of 0.
Among the 55 patients analyzed (29 infliximab and 26 cyclosporine), 49 (83%) had UCEIS ≥6 at baseline at baseline. Partial endoscopic remission rates were higher for bleeding than for vascular pattern and for ulcerations/erosions at day 7 (20% vs. 4% and 5% (n = 55); p = .004 and p=.04), for bleeding and ulceration/erosion than for vascular pattern at day 42 [63% and 65% vs. 33% (n=54); p<.001 for both] and at day 98 [78% and 92% vs. 56% (n = 50); p = .007 and p < .001]. Global endoscopic remission rates at day 98 were higher in patients treated with infliximab than with cyclosporine [73% vs. 25% (n = 26 and 24); p < .001].
In steroid-refractory ASUC patients responding to a second-line medical therapy, endoscopic remission process started with bleeding remission and was not achieved in half the patients at day 98 for vascular pattern. Infliximab provided a higher endoscopic remission rate than cyclosporine at day 98.
背景/目的：急性重度溃疡性结肠炎（ASUC）患者的内镜检查结果演变数据较少。本研究旨在前瞻性队列中描述这种演变。
纳入接受类固醇治疗反应不佳的 ASUC 患者，并在第 98 天达到无类固醇临床缓解的患者，可参与比较英夫利昔单抗和环孢素的随机试验。在基线、第 7 天、第 42 天和第 98 天进行柔性乙状结肠镜检查。根据溃疡性结肠炎内镜严重程度指数（UCEIS）及其亚评分 - 血管模式、出血和溃疡/糜烂 - 进行了事后计算。通过 UCEIS 为 0 定义总体内镜缓解，通过任何 UCEIS 亚评分 0 定义部分内镜缓解。
在分析的 55 例患者中（英夫利昔单抗 29 例，环孢素 26 例），49 例（83%）基线时 UCEIS≥6。第 7 天，出血的部分内镜缓解率高于血管模式和溃疡/糜烂[20% 与 4%和 5%（n=55）；p=0.004 和 p=0.04]，第 42 天，出血和溃疡/糜烂的部分内镜缓解率高于血管模式[63%和 65%与 33%（n=54）；p<0.001 均]，第 98 天[78%和 92%与 56%（n=50）；p=0.007 和 p<0.001]。第 98 天，接受英夫利昔单抗治疗的患者的总体内镜缓解率高于接受环孢素治疗的患者[73%与 25%（n=26 和 24）；p<0.001]。
在对二线药物治疗有反应的类固醇难治性 ASUC 患者中，内镜缓解过程始于出血缓解，第 98 天血管模式的缓解率不到一半。与环孢素相比，第 98 天英夫利昔单抗的内镜缓解率更高。
