Zhou Longyuan, Hu Cicong, Zhang Ruonan, Qiu Yun, Wang Yu, Liu Zishan, Chen Baili, He Yao, Zeng Zhirong, Li Xuehua, Mao Ren, Chen Minhu
Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People's Republic of China.
Department of Radiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People's Republic of China.
Therap Adv Gastroenterol. 2023 May 6;16:17562848231170947. doi: 10.1177/17562848231170947. eCollection 2023.
Transmural healing (TH) is a potential therapeutic goal of Crohn's disease (CD) and is associated with better clinical outcomes. However, few studies have described early TH and its predictors.
We aimed to evaluate early TH and its predictors using magnetic resonance enterography (MRE) in patients with CD receiving ustekinumab (UST).
This was a retrospective observational study.
Patients with active CD treated with UST and their intestinal segments with bowel wall thickness (BWT) ⩽ 3 mm at baseline were included. Clinical characteristics, laboratory indicators, endoscopic manifestations, and MRE indices were evaluated at baseline and week 26 (W26) of the therapy. The following MRE parameters were assessed: BWT, edema, apparent diffusion coefficient (ADC), Clermont score, Magnetic Resonance Index of Activity score, fat stranding, comb sign, and stricture. TH was defined as BWT ⩽ 3 mm without any signs of inflammation (i.e., ulceration, edema, diffusion-weighted hyperintensity, and increased contrast enhancement) at W26.
The study included 37 patients with 106 intestinal segments (including 15 proximal small intestines, 33 terminal ilea, and 58 colons). Clinical features, laboratory indicators, endoscopic results, and MRE parameters at W26 were significantly improved after UST treatment in both patient-based and intestinal segment-based analysis. Seven (18.9%) patients and 26 (24.5%) intestinal segments achieved TH at W26. Baseline BWT [odds ratio (OR) = 0.287, 95% confidence interval (CI), 0.090-0.918, = 0.035] and ADC (OR = 2.997, 95% CI, 1.009-8.908, = 0.048) predict TH of patients at W26. Baseline ADC (OR = 2.857, 95% CI, 1.285-6.349, = 0.010) and presence of stenosis (OR = 0.196, 95% CI, 0.052-0.735, = 0.016) were associated with TH of segments at W26.
Early TH assessed by MRE was observed in nearly one-fifth of patients with CD and intestinal segments after UST treatment for 26 weeks. Baseline MRE indices such as BWT and presence of stenosis might negatively predict TH, while ADC might positively predict early TH.
透壁愈合（TH）是克罗恩病（CD）潜在的治疗目标，且与更好的临床结局相关。然而，很少有研究描述早期透壁愈合及其预测因素。
我们旨在使用磁共振小肠造影（MRE）评估接受优特克单抗（UST）治疗的CD患者的早期透壁愈合及其预测因素。
这是一项回顾性观察研究。
纳入接受UST治疗的活动性CD患者及其基线时肠壁厚度（BWT）≤3mm的肠段。在治疗的基线和第26周（W26）评估临床特征、实验室指标、内镜表现和MRE指标。评估以下MRE参数：BWT、水肿、表观扩散系数（ADC）、克莱蒙评分、磁共振活动指数评分、脂肪沉积、梳征和狭窄。透壁愈合定义为在W26时BWT≤3mm且无任何炎症迹象（即溃疡、水肿、扩散加权高信号和对比增强增加）。
该研究纳入了37例患者的106个肠段（包括15个近端小肠、33个回肠末端和58个结肠）。在基于患者和基于肠段的分析中，UST治疗后W26时的临床特征、实验室指标、内镜结果和MRE参数均有显著改善。7例（18.9%）患者和26个（24.5%）肠段在W26时实现了透壁愈合。基线BWT[比值比（OR）=0.287，95%置信区间（CI），0.090-0.918，P=0.035]和ADC（OR=2.997，95%CI，1.009-8.908，P=0.048）可预测患者在W26时的透壁愈合。基线ADC（OR=2.857，95%CI，1.285-6.349，P=0.010）和狭窄的存在（OR=0.196，9%CI，0.052-0.735，P=0.016）与W26时肠段的透壁愈合相关。
在接受UST治疗26周后的近五分之一的CD患者和肠段中观察到通过MRE评估的早期透壁愈合。基线MRE指标如BWT和狭窄的存在可能对透壁愈合有负向预测作用，而ADC可能对早期透壁愈合有正向预测作用。
