Wan Jian, Wang Xuan, Zhang Yujie, Xue Xianmin, Jia Hui, Wang Min, Liang Jie, Wu Kaichun
State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, Shaanxi, P. R. China.
Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, P. R. China.
Gastroenterol Rep (Oxf). 2022 May 18;10:goac019. doi: 10.1093/gastro/goac019. eCollection 2022.
Ulcerative colitis (UC) is a chronic lifelong disease. The disease extent of UC can progress over time. This study aimed to assess whether cumulative inflammatory burden (CIB) is associated with disease extension in distal UC (proctitis [E1] and left-sided colitis [E2]) patients, and to develop a quantified indicator of CIB.
In this retrospective study based on a prospective registry, distal UC patients receiving colonoscopies in Xijing Hospital (Xi'an, China) from January 2000 to May 2019 were studied. We developed a new score, namely the time-adjusted average Mayo endoscopic score (TA-MES), calculated as dividing the sum of the cumulative average MES over a period of surveillance time by the length of the endoscopic examination interval, to quantify the CIB. Cox regression was used to identify other potential risk factors.
A total of 295 UC patients were followed for 1,487.02 patient-years. Among them, 140 patients (47.5%) experienced disease extension. Multivariate analysis showed that the TA-MES was significantly associated with disease extension in E1 (hazard ratio [HR], 2.90; 95% confidence interval [CI], 1.58-5.33, =0.001) and E2 (HR, 1.89; 95% CI, 1.16-3.09, =0.011) patients. Other risk factors included hemoglobin of <90 g/L and appendiceal skip inflammation; the protective factors included age, E2 at diagnosis, former smoking, and 5-aminosalicylic acid dose. Otherwise, MES at diagnosis, maximal MES, and mean MES failed to estimate the risk of disease extension.
TA-MES is a good quantified indicator of CIB and is independently associated with increased disease extension in distal UC patients. Whether the dynamic multiple scoring system could be used as a risk factor in other chronic relapsing-remitting diseases is a direction for future research.
溃疡性结肠炎（UC）是一种慢性终身疾病。UC的病变范围会随时间进展。本研究旨在评估累积炎症负担（CIB）是否与远端UC（直肠炎[E1]和左侧结肠炎[E2]）患者的疾病扩展相关，并建立一种CIB的量化指标。
在这项基于前瞻性登记的回顾性研究中，对2000年1月至2019年5月在西京医院（中国西安）接受结肠镜检查的远端UC患者进行了研究。我们开发了一种新的评分，即时间调整后的平均梅奥内镜评分（TA-MES），计算方法是将监测期内累积平均MES之和除以内镜检查间隔时间长度，以量化CIB。采用Cox回归来识别其他潜在风险因素。
共对295例UC患者进行了1487.02患者年的随访。其中，140例患者（47.5%）出现疾病扩展。多变量分析显示，TA-MES与E1（风险比[HR]，2.90；95%置信区间[CI]，1.58 - 5.33，P = 0.001）和E2（HR，1.89；95% CI，1.16 - 3.09，P = 0.011）患者的疾病扩展显著相关。其他风险因素包括血红蛋白<90 g/L和阑尾跳跃性炎症；保护因素包括年龄、诊断时为E2、既往吸烟和5-氨基水杨酸剂量。此外，诊断时的MES、最大MES和平均MES未能评估疾病扩展风险。
TA-MES是CIB的良好量化指标，并且与远端UC患者疾病扩展增加独立相关。动态多评分系统是否可作为其他慢性复发缓解性疾病的风险因素是未来研究的一个方向。
