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肠超声定义的壁内反应和壁内愈合:新的潜在治疗靶点?

Transmural Response and Transmural Healing Defined by Intestinal Ultrasound: New Potential Therapeutic Targets?

机构信息

University Hospital of Kiel, 1st Medical Department, Arnold Heller Str. 9, 24105 Kiel, Germany.

Private Practice for Internal Medicine, Department of Gastroenterology, Neue Donnerschweer Str. 30, 26123 Oldenburg, Germany.

出版信息

J Crohns Colitis. 2022 Jan 28;16(1):57-67. doi: 10.1093/ecco-jcc/jjab106.

DOI:10.1093/ecco-jcc/jjab106
PMID:34185843
Abstract

BACKGROUND AND AIMS

Intestinal ultrasound [IUS] is a useful modality to monitor patients with inflammatory bowel disease [IBD]. Little is known about the use of IUS and appropriate definitions for transmural response [TR] and healing [TH]. We aimed to establish the use of IUS in monitoring TH as a potential target in routine medical practice.

METHODS

Based on the prospective, non-interventional, multicentre studies TRUST and TRUST&UC, we conducted a post-hoc analysis of 351 IBD patients with increased bowel wall thickness [BWT]. We analysed the rates of patients achieving TR and TH, comparing three definitions of TH. In 137 Crohn's disease [CD] patients, the predictive value of TR and TH was investigated for the clinical and sonographic outcome at week 52.

RESULTS

Within 12 weeks of treatment intensification, 65.6% [n = 118] of CD patients and 76.6% [n = 131] of ulcerative colitis [UC] patients showed a TR. Depending on the definition, 23.9-37.2% [n = 58/67/43] of CD patients and 45.0-61.4% [n = 90/105/77] of UC patients had TH at week 12. CD patients with TH were more likely to reach clinical remission at week 12 (odds ratio [OR] 3.33 [1.09-10.2]; p = 0.044) and a favourable sonographic outcome (OR 5.59 [1.97-15.8]; p = 0.001) at week 52 compared with patients without TH.

CONCLUSIONS

IUS response and TH in a relevant proportion of patients suggests that IUS is a useful method to assess transmural inflammatory activity in daily clinical practice. TR and TH are predictive for the sonographic outcome at week 52.

摘要

背景与目的

肠超声[IUS]是一种监测炎症性肠病[IBD]患者的有用手段。对于 IUS 的应用以及透壁反应[TR]和愈合[TH]的适当定义知之甚少。我们旨在确定 IUS 在监测 TH 中的应用,作为常规医疗实践中的一个潜在目标。

方法

基于前瞻性、非干预性、多中心研究 TRUST 和 TRUST&UC,我们对 351 例肠壁增厚[BWT]增加的 IBD 患者进行了一项事后分析。我们分析了三种 TH 定义下达到 TR 和 TH 的患者比例。在 137 例克罗恩病[CD]患者中,我们研究了 TR 和 TH 的预测价值,以评估第 52 周的临床和超声结果。

结果

在强化治疗的 12 周内,65.6%[n=118]的 CD 患者和 76.6%[n=131]的溃疡性结肠炎[UC]患者出现 TR。根据定义,23.9-37.2%[n=58/67/43]的 CD 患者和 45.0-61.4%[n=90/105/77]的 UC 患者在第 12 周时出现 TH。在第 12 周时,达到 TH 的 CD 患者更有可能达到临床缓解(比值比[OR]3.33[1.09-10.2];p=0.044),并且在第 52 周时出现有利的超声结果(OR 5.59[1.97-15.8];p=0.001),与没有 TH 的患者相比。

结论

在相当一部分患者中,IUS 反应和 TH 表明 IUS 是一种在日常临床实践中评估透壁炎症活动的有用方法。TR 和 TH 可预测第 52 周的超声结果。

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