Steinsbø Øyvind, Carlsen Arne, Aasprong Ole Gunnar, Aabakken Lars, Tvedt-Gundersen Espen, Bjørkhaug Steinar, Gjerde Rune, Normann Karlsen Lars, Grimstad Tore
Department of Medical Gastroenterology, Stavanger University Hospital, Gerd-Ragna Bloch Thorsens gate 8, Stavanger, 4068, Norway.
Department of Medical Gastroenterology, Stavanger University Hospital, Stavanger, Norway.
Therap Adv Gastroenterol. 2022 Dec 6;15:17562848221140659. doi: 10.1177/17562848221140659. eCollection 2022.
Endoscopic and histological activity scores in ulcerative colitis (UC) are associated with clinical outcomes and have become important targets of clinical trials. However, these endpoints have been scarcely investigated in patients receiving only conventional treatment.
We aimed to assess the deep and complete remission rates after 3 months of conventional treatment in patients with newly diagnosed UC with moderate to severe endoscopic activity. We also aimed to investigate whether selected clinical and biochemical variables at baseline were associated with complete remission status after 3 months.
This was a prospective cohort study.
Newly diagnosed patients with active UC commencing 5-aminosalicylate, corticosteroid, and/or azathioprine treatment were consecutively included. Clinical, biochemical, endoscopic, and histological data were collected at baseline and after 3 months. Rates of (Partial Mayo Score ⩽ 2), (Mayo Endoscopic Score ⩽ 1), and (Nancy Index ⩽ 1) were determined. was assessed as clinical remission plus mucosal healing and as deep remission plus histologic healing. Predictors of complete remission were identified by logistic regression.
A total of 180 patients were included in the study. Deep remission and complete remission occurred in 62.8% and 42.2% of patients, respectively. Thus, of patients in deep remission one-third had persistent histologic activity. Histologic activity in mucosally healed patients was associated with higher symptom scores and faecal calprotectin levels. Of baseline variables, less endoscopic distribution and disease activity showed strongest association with achieving complete remission, and limited distribution in combination with moderate activity gave highest odds for complete remission (odds ratio: 4.1, 95% confidence interval: 7.69-2.18).
In patients with mucosal healing, persistent histologic activity was a common finding and was associated with increased disease activity. Pancolitis and severe inflammatory activity at baseline were associated with lower complete remission rates.
溃疡性结肠炎（UC）的内镜和组织学活动评分与临床结局相关，已成为临床试验的重要目标。然而，这些终点指标在仅接受传统治疗的患者中很少被研究。
我们旨在评估新诊断的中度至重度内镜活动的UC患者在接受3个月传统治疗后的深度缓解率和完全缓解率。我们还旨在研究基线时选定的临床和生化变量是否与3个月后的完全缓解状态相关。
这是一项前瞻性队列研究。
连续纳入开始接受5-氨基水杨酸、皮质类固醇和/或硫唑嘌呤治疗的新诊断活动性UC患者。在基线和3个月后收集临床、生化、内镜和组织学数据。确定部分梅奥评分（Partial Mayo Score）≤2、梅奥内镜评分（Mayo Endoscopic Score）≤1和南希指数（Nancy Index）≤1的比例。完全缓解被评估为临床缓解加黏膜愈合，深度缓解被评估为深度缓解加组织学愈合。通过逻辑回归确定完全缓解的预测因素。
共有180例患者纳入研究。分别有62.8%和42.2%的患者实现了深度缓解和完全缓解。因此，在深度缓解的患者中，三分之一有持续的组织学活动。黏膜愈合患者的组织学活动与更高的症状评分和粪便钙卫蛋白水平相关。在基线变量中，内镜下分布范围较小和疾病活动度较低与实现完全缓解的关联最强，有限的分布与中度活动相结合实现完全缓解的几率最高（优势比：4.1，95%置信区间：7.69 - 2.18）。
在黏膜愈合的患者中，持续的组织学活动是常见现象，且与疾病活动度增加相关。全结肠炎和基线时的严重炎症活动与较低的完全缓解率相关。
