溃疡性结肠炎内镜愈合治疗后组织学缓解的预测因素和结果。
Predictors and outcomes of histological remission in ulcerative colitis treated to endoscopic healing.
机构信息
Division of Gastroenterology, University of California San Diego, La Jolla, CA, USA.
Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam-si, South Korea.
出版信息
Aliment Pharmacol Ther. 2020 Sep;52(6):1008-1016. doi: 10.1111/apt.16026. Epub 2020 Aug 9.
BACKGROUND
Clinical remission is the recommended treatment target in ulcerative colitis. The predictors and outcomes of achieving histologic remission within a treat-to-target paradigm are not well established.
AIM
To evaluate the predictors and outcomes of achieving histologic remission in patients with ulcerative colitis treated-to-target of endoscopic healing (modified Mayo endoscopy score 0 or 1).
METHODS
We conducted a retrospective cohort study in adults with active ulcerative colitis (modified Mayo endoscopy score 2 or 3), whose treatment was iteratively optimised to achieve endoscopic healing. We identified predictors of achieving histologic remission, and outcomes (risk of symptomatic relapse, and ulcerative colitis-related hospitalisation and/or surgery) of achieving histologic remission vs persistent histologic activity, using Cox proportional hazard analysis.
RESULTS
Of the 411 patients with clinically active ulcerative colitis, 270 achieved endoscopic healing. Of the 270 patients, 55% simultaneously achieved histologic remission. Depth of endoscopic healing at final endoscopic assessment was the only independent determinant of histologic remission (modified Mayo endoscopy score 0 vs 1: odds ratio, 0.31 [95% confidence intervals, 0.18-0.52]). Over 28 months, achieving histologic remission was associated with a lower risk of clinical relapse (1-year cumulative risk: 18.7% vs 29.5%; adjusted hazard ratio, 0.56 [0.37-0.85]), and lower risk of hospitalisation (hazard ratio, 0.44 [0.20-0.94]). The incremental benefit of achieving histologic remission was observed only in patients achieving Mayo endoscopy score 1, but not Mayo endoscopy score 0.
CONCLUSIONS
In patients with active ulcerative colitis treated-to-target of endoscopic healing, 55% simultaneously achieved histologic remission. Histologic remission, particularly in patients achieving modified Mayo endoscopy score 1, was associated with favourable outcomes. Treating to a target of histologic remission over endoscopic healing requires prospective evaluation.
背景
临床缓解是溃疡性结肠炎的推荐治疗目标。在靶向治疗的背景下，实现组织学缓解的预测因素和结果尚不清楚。
目的
评估接受靶向内镜愈合（改良 Mayo 内镜评分 0 或 1）治疗的溃疡性结肠炎患者达到组织学缓解的预测因素和结果。
方法
我们对患有活动性溃疡性结肠炎（改良 Mayo 内镜评分 2 或 3）的成年人进行了一项回顾性队列研究，他们的治疗被反复优化以达到内镜愈合。我们确定了实现组织学缓解的预测因素，以及实现组织学缓解与持续组织学活动的结果（症状性复发的风险，以及溃疡性结肠炎相关的住院和/或手术），使用 Cox 比例风险分析。
结果
在 411 例有临床活动性溃疡性结肠炎的患者中，270 例达到了内镜愈合。在 270 例患者中，55%同时达到了组织学缓解。最终内镜评估时的内镜愈合深度是组织学缓解的唯一独立决定因素（改良 Mayo 内镜评分 0 与 1：优势比，0.31 [95%置信区间，0.18-0.52]）。在 28 个月的时间里，达到组织学缓解与较低的临床复发风险相关（1 年累积风险：18.7%与 29.5%；调整后的危险比，0.56 [0.37-0.85]），以及较低的住院风险（危险比，0.44 [0.20-0.94]）。达到组织学缓解的增量获益仅在达到改良 Mayo 内镜评分 1 的患者中观察到，而在达到改良 Mayo 内镜评分 0 的患者中则没有观察到。
结论
在接受靶向内镜愈合治疗的活动性溃疡性结肠炎患者中，55%同时达到了组织学缓解。组织学缓解，特别是在达到改良 Mayo 内镜评分 1 的患者中，与良好的结果相关。将治疗目标设定为组织学缓解而非内镜愈合需要前瞻性评估。
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