Yarlas Aaron, Willian Mary Kaye, Nag Arpita
QualityMetric, 1301 Atwood Avenue, Suite 216E, Johnston, RI, 02919, USA.
Shire, 725 Chesterbrook Boulevard, Wayne, PA, 19087, USA.
Qual Life Res. 2021 Jul;30(7):1925-1938. doi: 10.1007/s11136-021-02787-4. Epub 2021 Mar 2.
Studies of patients with ulcerative colitis (UC) report that reduced clinical symptoms and endoscopic activity predict better health-related quality of life (HRQoL). However, no study has examined the joint and unique associations of clinical and endoscopic activity with HRQoL, nor of histologic inflammation and HRQoL. These post hoc analyses evaluated whether reduced clinical, endoscopic, and histologic disease activity were uniquely associated with improved HRQoL for adults with active mild-to-moderate UC receiving once-daily 4.8 g/day multimatrix mesalazine for 8 weeks.
Assessments at baseline and week 8 (i.e., treatment completion) included clinical and endoscopic activity (modified UC-Disease Activity Index), histology (Geboes scoring), and HRQoL (Short Inflammatory Bowel Disease Questionnaire [SIBDQ]; SF-12v2 Health Survey [SF-12v2]). Associations among each type of disease activity and HRQoL were examined by correlations and by mean changes in SIBDQ and SF-12v2 scores between disease activity subgroups (e.g., achievement of clinical remission; mucosal healing). Regression models estimated unique variance in HRQoL accounted by each type of disease activity.
Within the analysis sample (n = 717), patients with reduced clinical and endoscopic activity had significantly larger improvements in all HRQoL domains (p < 0.001), as did patients in both endoscopic and clinical remission compared to patients in endoscopic remission only (p < 0.05). Patients with histologic activity post-treatment scored significantly worse on all HRQoL domains than patients with no activity (p < 0.05). Correlations and regression models found that decreases in clinical and endoscopic activity were associated with improvements in HRQoL domain scores.
Clinical symptoms and mucosal health have separable, distinct impacts on UC patients' HRQoL.
对溃疡性结肠炎（UC）患者的研究报告称，临床症状减轻和内镜下活动度降低预示着与健康相关的生活质量（HRQoL）更好。然而，尚无研究探讨临床和内镜下活动度与HRQoL的联合及独特关联，也未涉及组织学炎症与HRQoL的关系。这些事后分析评估了对于接受每日一次4.8 g/天多基质美沙拉嗪治疗8周的轻至中度活动性UC成年患者，临床、内镜和组织学疾病活动度降低是否与HRQoL改善存在独特关联。
在基线和第8周（即治疗结束时）进行的评估包括临床和内镜下活动度（改良UC疾病活动指数）、组织学（ Geboes评分）以及HRQoL（简短炎症性肠病问卷[SIBDQ]；SF-12v2健康调查[SF-12v2]）。通过相关性分析以及疾病活动度亚组（例如临床缓解的达成；黏膜愈合）之间SIBDQ和SF-12v2评分的平均变化，研究每种类型的疾病活动度与HRQoL之间的关联。回归模型估计每种类型的疾病活动度在HRQoL中所占的独特方差。
在分析样本（n = 717）中，临床和内镜下活动度降低的患者在所有HRQoL领域均有显著更大的改善（p < 0.001），与仅处于内镜缓解的患者相比，处于内镜和临床缓解的患者也是如此（p < 0.05）。治疗后有组织学活动的患者在所有HRQoL领域的得分均显著低于无活动的患者（p < 0.05）。相关性分析和回归模型发现，临床和内镜下活动度的降低与HRQoL领域得分的改善相关。
临床症状和黏膜健康对UC患者的HRQoL有可分离的、不同的影响。
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