Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy.
Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy.
Aliment Pharmacol Ther. 2021 Jan;53(2):273-280. doi: 10.1111/apt.16167. Epub 2020 Nov 18.
Rates of elderly patients with inflammatory bowel diseases (IBDs) are increasing, and biomarkers are needed to optimise their therapies. Serum triiodothyronine-to-thyroxine (T3/T4) ratio has been correlated with geriatric patient frailty.
To assess the suitability of T3/T4 ratio as a response marker to biologics in elderly patients with IBD.
Patients with IBD over 60 years old were enrolled, when starting biological therapy. Therapeutic outcome was assessed after 54 weeks of treatment as mucosal healing (Mayo endoscopic score < 2 for ulcerative colitis; ulcer disappearance for Crohn's disease) and clinical remission (Partial Mayo Score < 2 for ulcerative colitis; Harvey-Bradshaw Index < 5 for Crohn's disease). T3/T4 ratio was evaluated at baseline, and its association with therapeutic outcomes was tested by multivariable logistic regression and receiver operating characteristic (ROC).
We enrolled 80 patients; 44 achieved clinical remission and 36 mucosal healing. Baseline T3/T4 ratio was higher in patients with mucosal healing, as compared with those without mucosal healing (P < 0.0001), regardless of the disease type or biological drug (OR 6.4 [2.9-14.3] for each T3/T4 unit increase, P < 0.0001). A cut point of 3.3 was identified as the optimal threshold of baseline T3/T4 ratio for predicting mucosal healing, providing 78% sensitivity and 89% specificity (area under the ROC curve 0.88 [0.79-0.94]; positive and negative likelihood ratios 6.8 [2.9-15.9] and 0.3 [0.1-0.5] respectively).
T3/T4 ratio seems a reliable tool for predicting therapeutic outcome of biological therapy in elderly patients with IBD. If validated, the assessment of this parameter before starting biological treatment might be suggested.
患有炎症性肠病（IBD）的老年患者人数正在增加，需要生物标志物来优化他们的治疗方法。血清三碘甲状腺原氨酸/甲状腺素（T3/T4）比值与老年患者衰弱有关。
评估 T3/T4 比值作为生物标志物在老年 IBD 患者对生物制剂应答的适用性。
招募年龄超过 60 岁的 IBD 患者，开始接受生物治疗时入组。治疗 54 周后，通过黏膜愈合（溃疡性结肠炎的 Mayo 内镜评分<2；克罗恩病的溃疡消失）和临床缓解（溃疡性结肠炎的部分 Mayo 评分<2；克罗恩病的 Harvey-Bradshaw 指数<5）来评估治疗效果。在基线时评估 T3/T4 比值，并通过多变量逻辑回归和受试者工作特征（ROC）曲线分析其与治疗结果的关系。
共纳入 80 例患者；44 例达到临床缓解，36 例达到黏膜愈合。与未达到黏膜愈合的患者相比，达到黏膜愈合的患者基线 T3/T4 比值更高（P<0.0001），无论疾病类型或生物药物如何（T3/T4 单位增加一个单位，OR 6.4[2.9-14.3]，P<0.0001）。确定 3.3 为基线 T3/T4 比值预测黏膜愈合的最佳阈值，灵敏度为 78%，特异性为 89%（ROC 曲线下面积 0.88[0.79-0.94]；阳性和阴性似然比分别为 6.8[2.9-15.9]和 0.3[0.1-0.5]）。
T3/T4 比值似乎是预测老年 IBD 患者生物治疗疗效的可靠工具。如果得到验证，在开始生物治疗前评估该参数可能是有意义的。
