Ilvemark Johan F K F, Wilkens Rune, Thielsen Peter, Dige Anders, Boysen Trine, Brynskov Jørn, Bjerrum Jacob Tveiten, Seidelin Jakob Benedict
Department of Gastroenterology and Hepatology, Copenhagen University Hospital - Gentofte and Herlev, Herlev, Denmark.
Gastrounit, Medical Division, Copenhagen University Hospital, Copenhagen Center for Inflammatory Bowel Disease in Children, Adolescents and Adults, Copenhagen University Hospital - Amager and Hvidovre, Digestive Disease Centre, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark.
J Crohns Colitis. 2022 Nov 23;16(11):1725-1734. doi: 10.1093/ecco-jcc/jjac083.
Our aim was to determine if transabdominal intestinal ultrasound changes after 48 ± 24 h of intravenous corticosteroids can predict treatment outcomes in hospitalised patients with severe ulcerative colitis.
We performed a blinded observational multicentre study. Ultrasound parameters were assessed before treatment initiation, after 48 ± 24 h, and 6 ± 1 days. Treatment response was determined within 7 days by two outcome measures: 1] partial Mayo score reduction; 2] no administration of rescue therapy.
Out of 69 recruited patients, 56 were included in the final analysis, with 37 responders. The colon segment with the highest baseline bowel wall thickness was analysed, being the sigmoid in all patients. There was no difference in baseline bowel wall thickness between responders and non-responders in the partial Mayo score outcome. At 48 ± 24 h, a significant difference between responders and non-responders was identified in both absolute bowel wall thickness [median 3.1 mm vs 4.9 mm; p <0.0001], absolute reduction [-1.9 mm vs -0.2 mm; p <0.001], and relative reduction [-35.9% vs -4.1%; p <0.0001]. A ≤20% reduction had a sensitivity of 84.2% (95% confidence interval [CI] 60.4, 96.6%) and a specificity of 78.4% [61.8, 90.2%] for determining non-response [area under the curve 0.85]. In the multivariable analysis, a >20% reduction had the highest odds ratio (22.6 [4.2, 201.2]; p = 0.001) for determining response. Similar results were seen for the rescue therapy outcome.
Changes in bowel wall thickness, after 48 ± 24 h following intravenous corticosteroid treatment in hospitalised patients with severe ulcerative colitis, identify responders with high accuracy and might be used as an early marker to guide accelerated rescue therapy.
我们的目的是确定在静脉注射皮质类固醇48±24小时后经腹肠道超声的变化是否能够预测重度溃疡性结肠炎住院患者的治疗结局。
我们开展了一项双盲观察性多中心研究。在治疗开始前、48±24小时后以及6±1天时评估超声参数。在7天内通过两项结局指标确定治疗反应：1]梅奥评分部分降低；2]未给予挽救治疗。
在69名招募的患者中，56名纳入最终分析，其中37名有反应。分析了基线肠壁厚度最高的结肠段，所有患者均为乙状结肠。在梅奥评分结局中，有反应者与无反应者的基线肠壁厚度无差异。在48±24小时时，有反应者与无反应者在绝对肠壁厚度[中位数3.1mm对4.9mm；p<0.0001]、绝对降低值[-1.9mm对-0.2mm；p<0.001]和相对降低值[-35.9%对-4.1%；p<0.0001]方面均存在显著差异。降低≤20%对于确定无反应的敏感性为84.2%（95%置信区间[CI]60.4，96.6%），特异性为78.4%[61.8，90.2%][曲线下面积0.85]。在多变量分析中，降低>20%对于确定反应的比值比最高（22.6[4.2，201.2]；p=0.001）。对于挽救治疗结局也观察到了类似结果。
在重度溃疡性结肠炎住院患者中，静脉注射皮质类固醇治疗48±24小时后肠壁厚度的变化能够高度准确地识别有反应者，并且可用作指导加速挽救治疗的早期标志物。
