[联合抗细胞因子和细胞疗法实现溃疡性结肠炎的组织学缓解]

[Histological remission of ulcerative colitis with combined anti-cytokine and cell therapy].

作者信息

Knyazev O V, Khomeriki S G, Kagramanova A V, Lishchinskaya A A, Smirnova O A, Noskova K K, Parfenov A I

机构信息

Loginov Moscow Clinical Scientific Center.

Ryzhykh National Medical Research Center of Coloproctology.

出版信息

Ter Arkh. 2021 Dec 15;93(12):1435-1442. doi: 10.26442/00403660.2021.12.201212.

DOI:10.26442/00403660.2021.12.201212

PMID:36286670

Abstract

AIM

To conduct comparative analysis of histological remission in patients with moderate and severe ulcerative colitis (UC), receiving biological therapy vedolizumab, mesenchymal stem cell (MSC) treatment and combined stem cells and vedolizumab therapy.

MATERIALS AND METHODS

We studied biopsies of 75 patients with total or left-sided moderate and severe ulcerative colitis, divided into groups depending on treatment. The first group of UC patients (n=29) received stem cell therapy 2 mln per kg; the second group of UC patients (n=27) received vedolizumab and the third group (n=19) MSC and vedolizumab. The efficacy of treatment was assessed by C reactive protein (CRP), Mayo score (MS), fecal calprotectin (FC) and Geboes score (GS).

RESULTS

We determined medium correlation between basic FC and MS before treatment (r=0.6605, p0.05). After 12 weeks of treatment in the first group of UC patients (n=29) CRP was 7.82.1 mg/l, FC 409.344.85 g/g, medium GS 1.20.1 points. After 12 weeks of treatment in the second group of UC patients (n=27) CRP was 8.41.4 mg/l, FC 435.547.3 g/g, medium GS 1.350.15 points. After 12 weeks of treatment in the third group of UC patients (n=19) CRP was 6.41.1 mg/l, FC 290.617.5 g/g, medium GS 0.90.1 points. We proved strong direct relationship between FC and GS after 12 weeks of treatment in UC patients, receiving MSC (r=0.8392, p0.05). The statistically significant majority of patients, achieved histological remission, have less than 5-year duration of disease.

CONCLUSION

Our study showed that clinical and endoscopic remission in UC patients does not always correlate with histological remission. Combined anti-cytokine and stem cells therapy contributes to achieve deep remission and decrease mucosa inflammation rather than single MSC or vedolizumab treatment. Deep remission could be achieved by earlier start of biological therapy. FC could be a predictor and marker of mucosa healing and histological remission.

摘要

目的

对中重度溃疡性结肠炎（UC）患者接受维多珠单抗生物治疗、间充质干细胞（MSC）治疗以及干细胞与维多珠单抗联合治疗后的组织学缓解情况进行比较分析。

材料与方法

我们研究了75例全结肠或左侧中重度溃疡性结肠炎患者的活检样本，根据治疗方法将其分组。第一组UC患者（n = 29）接受每千克200万的干细胞治疗；第二组UC患者（n = 27）接受维多珠单抗治疗，第三组（n = 19）接受MSC和维多珠单抗治疗。通过C反应蛋白（CRP）、梅奥评分（MS）、粪便钙卫蛋白（FC）和 Geboes评分（GS）评估治疗效果。

结果

我们确定了治疗前基础FC与MS之间存在中度相关性（r = 0.6605，p < 0.05）。第一组UC患者（n = 29）治疗12周后，CRP为7.8 ± 2.1 mg/l，FC为409.3 ± 44.85 μg/g，平均GS为1.2 ± 0.1分。第二组UC患者（n = 27）治疗12周后，CRP为8.4 ± 1.4 mg/l，FC为435.5 ± 47.3 μg/g，平均GS为1.35 ± 0.15分。第三组UC患者（n = 19）治疗12周后，CRP为6.4 ± 1.1 mg/l，FC为290.6 ± 17.5 μg/g，平均GS为0.9 ± 0.1分。我们证实，接受MSC治疗的UC患者治疗12周后，FC与GS之间存在强直接关系（r = 0.8392，p < 0.05）。在实现组织学缓解的患者中，统计学上显著多数患者的病程不到5年。