基于肠道超声和钙卫蛋白的综合评估可准确预测溃疡性结肠炎的组织学活动：一项队列研究。
Composite Assessment Using Intestinal Ultrasound and Calprotectin Is Accurate in Predicting Histological Activity in Ulcerative Colitis: A Cohort Study.
机构信息
IBD Service, Department of Gastroenterology, John Hunter Hospital, Newcastle, Australia.
Faculty of Health Sciences, School of Medicine, University of Adelaide, Adelaide, Australia.
出版信息
Inflamm Bowel Dis. 2024 Feb 1;30(2):190-195. doi: 10.1093/ibd/izad043.
BACKGROUND
Beyond endoscopic remission, histological remission in ulcerative colitis (UC) is predictive of clinical outcomes. Intestinal ultrasound (IUS) may offer a noninvasive surrogate marker for histological activity; however, there are limited data correlating validated ultrasound and histological indices.
AIM
Our aim was to determine the correlation of IUS activity in UC with a validated histological activity index.
METHODS
Twenty-nine prospective, paired, same-day IUS/endoscopy/histology/fecal calprotectin (FC) cases were included. Intestinal ultrasound activity was determined using the Milan Ultrasound Criteria, histological activity using the Nancy Histological Index, endoscopic activity using Mayo endoscopic subscore and Ulcerative Colitis Endoscopic Index of Severity, and clinical activity using the Simple Clinical Colitis Activity Score.
RESULTS
Histological activity demonstrated a significant linear association with overall IUS activity (coefficient 0.14; 95% CI, 0.03-0.25; P = .011). Intestinal ultrasound activity was also significantly associated with endoscopic activity (0.32; 95% CI, 0.14-0.49; P < 0.001), total Mayo score (0.31; 95% CI, 0.02-0.60; P = .036) but not FC (0.10; 95% CI, -0.01 to 0.21; P = .064) or clinical disease activity (0.04; 95% CI, -0.21 to 0.28; P = .768). A composite of IUS and FC showed the greatest association (1.31; 95% CI, 0.43-2.18; P = .003) and accurately predicted histological activity in 88% of cases (P = .007), with sensitivity of 88%, specificity 80%, positive predictive value 95%, and negative predictive value 57%.
CONCLUSIONS
Intestinal ultrasound is an accurate noninvasive marker of histological disease activity in UC, the accuracy of which is further enhanced when used in composite with FC. This can reduce the need for colonoscopy in routine care by supporting accurate point-of-care decision-making in patients with UC.
背景
溃疡性结肠炎（UC）的内镜缓解标准之外，组织学缓解可预测临床结局。肠超声（IUS）可能为组织学活动提供一种非侵入性替代标志物；然而，将验证的超声和组织学指数相关联的数据有限。
目的
我们的目的是确定 UC 中 IUS 活动与验证的组织学活动指数之间的相关性。
方法
纳入 29 例前瞻性、配对、同日 IUS/内镜/组织学/粪便钙卫蛋白（FC）的病例。肠超声活动使用米兰超声标准进行评估，组织学活动使用南希组织学指数进行评估，内镜活动使用 Mayo 内镜亚评分和溃疡性结肠炎内镜严重程度指数进行评估，临床活动使用简单临床结肠炎活动评分进行评估。
结果
组织学活动与总体 IUS 活动呈显著线性关联（系数 0.14；95%CI，0.03-0.25；P =.011）。肠超声活动与内镜活动（0.32；95%CI，0.14-0.49；P < 0.001）、总 Mayo 评分（0.31；95%CI，0.02-0.60；P =.036）显著相关，但与 FC（0.10；95%CI，-0.01 至 0.21；P =.064）或临床疾病活动（0.04；95%CI，-0.21 至 0.28；P =.768）无关。IUS 和 FC 的组合显示出最大的相关性（1.31；95%CI，0.43-2.18；P =.003），并能在 88%的病例中准确预测组织学活动（P =.007），其灵敏度为 88%，特异性为 80%，阳性预测值为 95%，阴性预测值为 57%。
结论
肠超声是 UC 组织学疾病活动的一种准确的非侵入性标志物，与 FC 联合使用时准确性进一步提高。这可以减少常规护理中结肠镜检查的需求，通过支持 UC 患者的即时决策，实现更准确的医疗决策。
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