Department of Gastroenterology, Royal Melbourne Hospital, Melbourne, Australia.
Department of Radiology, Royal Melbourne Hospital, Melbourne, Australia.
Aliment Pharmacol Ther. 2022 Jul;56(1):84-94. doi: 10.1111/apt.16892. Epub 2022 Mar 28.
Transmural healing has emerged as a treatment target in Crohn's disease (CD). We investigated whether transmural healing assessed with intestinal ultrasound (IUS) is associated with improved clinical outcomes in patients with CD in clinical remission.
Patients with CD in clinical remission at baseline (HBI <4) having IUS between August 2017 and June 2020 with at least 6-months' follow-up were retrospectively studied. Time to medication escalation, corticosteroid use and CD-related hospitalisation or surgery were compared by the presence or absence of sonographic healing, defined as bowel wall thickness ≤3 mm without hyperemia on color Doppler, inflammatory fat, or disrupted bowel wall stratification. Factors associated with survival were analyzed by Kaplan-Meier analysis using Cox proportional-hazard model.
Of 202 consecutive patients (50% male), sonographic inflammation was present in 61%. During median follow-up of 19 (IQR 13-27) months, medication escalation occurred in 52%, corticosteroid use in 23%, hospitalisation in 21%, and CD-related surgery in 13%. Sonographic healing was significantly associated with a reduced risk of medication escalation (p = 0.0018), corticosteroid use (p = 0.0247), hospitalisation (p = 0.0102), and surgery (p = 0.083). On multivariable analysis, sonographic healing was significantly associated with an increased odds of medication escalation-free survival (hazard ratio [HR]:1.94; 95% CI 1.23-3.06; p = 0.004) and corticosteroid-free survival (HR:2.41; 95% CI 1.24-4.67; p = 0.009), but not with hospitalisation or surgery.
In patients with CD in clinical remission, sonographic healing is associated with improved clinical outcomes. Further studies are needed to determine whether sonographic healing should be a treatment target.
透壁愈合已成为克罗恩病（CD）的治疗靶点。我们研究了在临床缓解期的 CD 患者中，使用肠超声（IUS）评估的透壁愈合是否与改善临床结局相关。
回顾性研究了 2017 年 8 月至 2020 年 6 月期间基线时处于临床缓解期（HBI＜4）且至少有 6 个月随访的患者，这些患者接受了 IUS 检查。通过超声检查是否存在愈合，即肠壁厚度≤3mm 且彩色多普勒无充血、无炎症性脂肪或肠壁分层中断，来比较存在和不存在超声愈合的患者之间药物升级、使用皮质类固醇、CD 相关住院或手术的时间。使用 Kaplan-Meier 分析和 Cox 比例风险模型分析与生存相关的因素。
202 例连续患者（50%为男性）中，61%存在超声炎症。在中位随访 19（IQR 13-27）个月期间，52%的患者需要药物升级，23%的患者需要使用皮质类固醇，21%的患者需要住院治疗，13%的患者需要进行 CD 相关手术。超声愈合与降低药物升级（p=0.0018）、皮质类固醇使用（p=0.0247）、住院（p=0.0102）和手术（p=0.083）的风险显著相关。多变量分析显示，超声愈合与药物升级无风险生存（HR：1.94；95%CI 1.23-3.06；p=0.004）和无皮质类固醇生存（HR：2.41；95%CI 1.24-4.67；p=0.009）的几率增加显著相关，但与住院或手术无关。
在临床缓解期的 CD 患者中，超声愈合与改善临床结局相关。需要进一步的研究来确定超声愈合是否应成为治疗靶点。
