Asonuma Kunio, Kobayashi Taku, Nakano Masaru, Sagami Shintaro, Kiyohara Hiroki, Matsubayashi Mao, Morikubo Hiromu, Miyatani Yusuke, Okabayashi Shinji, Yamazaki Hajime, Kuroki Yuichiro, Hibi Toshifumi
Center for Advanced IBD Research and Treatment, Kitasato University Kitasato Institute Hospital, Tokyo,Japan.
Department of Gastroenterology and Hepatology, Kitasato University Kitasato Institute Hospital, Tokyo,Japan.
Inflamm Bowel Dis. 2022 Feb 1;28(2):200-207. doi: 10.1093/ibd/izab062.
Mucosal healing is a treatment target for patients with ulcerative colitis. However, the relevance of proactive treatment for residual inflammation limited to the distal colon is unclear.
Patients with ulcerative colitis who had extensive colitis in clinical remission and underwent colonoscopy were retrospectively enrolled and followed up for 2 years. Patients with complete endoscopic remission (CER; Mayo endoscopic subscore [MES] of 0) and those with short-segment distal inflammation (SS; active inflammation only in the sigmoid colon and/or rectum with a proximal MES of 0) were compared for the incidence of minor (only symptomatic) and major (need for induction treatments or hospitalization) relapses.
A total of 91 patients with CER and 54 patients with SS were identified and 63 relapses (47 minor and 16 major) were analyzed. Univariate analysis showed that minor relapses were significantly more frequent in the SS group than in the CER group (hazard ratio [HR], 2.22; 95% confidence interval [CI], 1.25-3.97), but major relapses were not more frequent in the SS group than in the CER group (HR, 1.78; 95% CI, 0.65-4.83). Multivariable analysis showed that SS was the only risk factor significantly associated with minor relapse (HR, 2.38; 95% CI, 1.31-4.36). When the SS group was stratified by MES of 1 vs 2/3, minor relapses were significantly more frequent in the subgroup with MES of 2/3 than in the CER group, whereas the incidence of major relapse remained similar.
Residual short-segment distal inflammation is not a risk factor for major relapses as long as endoscopic remission is achieved in the proximal colon. Therefore, reactive but not proactive treatment may be appropriate for such lesions.
黏膜愈合是溃疡性结肠炎患者的治疗目标。然而，针对仅限于结肠远端的残留炎症进行积极治疗的相关性尚不清楚。
对临床缓解且接受结肠镜检查的广泛性结肠炎溃疡性结肠炎患者进行回顾性纳入并随访2年。比较完全内镜缓解（CER；梅奥内镜亚评分[MES]为0）和短节段远端炎症（SS；仅乙状结肠和/或直肠有活动性炎症，近端MES为0）患者轻微（仅出现症状）和严重（需要诱导治疗或住院）复发的发生率。
共确定91例CER患者和54例SS患者，并分析了63次复发（47次轻微复发和16次严重复发）。单因素分析显示，SS组轻微复发的频率显著高于CER组（风险比[HR]，2.22；95%置信区间[CI]，1.25 - 3.97），但SS组严重复发的频率并不高于CER组（HR，1.78；95%CI，0.65 - 4.83）。多变量分析显示，SS是与轻微复发显著相关的唯一危险因素（HR，2.38；95%CI，1.31 - 4.36）。当SS组按MES为1与2/3分层时，MES为2/3的亚组轻微复发频率显著高于CER组，而严重复发的发生率保持相似。
只要近端结肠实现内镜缓解，残留的短节段远端炎症就不是严重复发的危险因素。因此，对此类病变进行反应性而非预防性治疗可能是合适的。
