Department of Internal Medicine and Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea.
Gut Liver. 2021 Nov 15;15(6):858-866. doi: 10.5009/gnl20294.
BACKGROUND/AIMS: Few studies have investigated terminal ileal lesions and their prognostic value in patients with ulcerative colitis (UC). We evaluated the clinical significance of these lesions as a prognostic factor in patients with UC who were in clinical remission.
We retrospectively selected 567 of 4,066 colonoscopy reports that included positive findings from orificial observations of the terminal ileum (TI) and appendix in patients with UC. We finally recruited patients who were in clinical remission (n=204). We compared the clinical courses, including relapse and other prognostic parameters associated with UC, between the groups.
The baseline patient characteristics were not significantly different between patients with (n=69, TI+ group) and without TI lesions (n=135, TI- group), although there were more never-smokers in the TI+ group (n=57 [82.6%] in the TI+ group; n=86 [63.7%] in the TI- group; p=0.005). Of note, appendiceal orifice inflammation (AOI) was less frequently found in the TI+ group (14.5%) than in the TI- group (71.9%, p<0.001). The cumulative relapse rate was numerically higher in the TI- group, but it was not significantly different according to the Kaplan-Meier analysis (p=0.116). Multivariate Cox regression analysis also revealed advanced age at diagnosis as the most significant factor (adjusted hazard ratio, 0.964; 95% confidence interval, 0.932 to 0.998; p=0.037), but neither TI inflammation nor AOI were significantly associated with the cumulative relapse rate in patients with UC in clinical remission.
For patients with UC in clinical remission, neither terminal ileal lesions nor AOI had significant clinical or predictive value for future relapse.
背景/目的：很少有研究调查溃疡性结肠炎（UC）患者的末端回肠病变及其预后价值。我们评估了这些病变作为临床缓解的 UC 患者的预后因素的临床意义。
我们回顾性选择了 4066 例结肠镜检查报告中的 567 例，这些报告包括 UC 患者的末端回肠（TI）和阑尾的口部观察阳性发现。我们最终招募了处于临床缓解的患者（n=204）。我们比较了两组之间的临床病程，包括复发和与 UC 相关的其他预后参数。
尽管 TI+组（n=57 [82.6%]）中从不吸烟者的比例更高（n=86 [63.7%]），但基线患者特征在有（n=69，TI+组）和无 TI 病变的患者（n=135，TI-组）之间没有显著差异（p=0.005）。值得注意的是，TI+组的阑尾口炎（AOI）发生率较低（14.5%），而 TI-组的 AOI 发生率较高（71.9%，p<0.001）。TI-组的累积复发率较高，但 Kaplan-Meier 分析显示差异无统计学意义（p=0.116）。多变量 Cox 回归分析还显示，诊断时的年龄较大是最显著的因素（调整后的危险比，0.964；95%置信区间，0.932 至 0.998；p=0.037），但 TI 炎症和 AOI 均与临床缓解的 UC 患者的累积复发率无显著相关性。
对于处于临床缓解的 UC 患者，末端回肠病变和 AOI 均对未来复发无显著的临床或预测价值。
