State Monica, Balanescu Paul, Voiosu Theodor, Bengus Andreea, Voiosu Andrei, Coman Andrei, Mustatea Petronel, Negreanu Lucian, Mateescu Radu Bogdan, Popp Cristiana
Gastroenterology Department, Colentina Clinical Hospital, 020125 Bucharest, Romania.
Internal Medicine Department, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania.
Biomedicines. 2023 Jun 29;11(7):1860. doi: 10.3390/biomedicines11071860.
BACKGROUND: Histologic activity has emerged as an aspirational therapeutic goal in ulcerative colitis management. It is not yet a formal treatment target in ulcerative colitis. However, it could be used as an adjunct to mucosal healing to represent a deeper level of healing. We investigated mucosal and histologic remission rates and potential predictors of these outcomes in a cohort of UC patients. METHODS: We conducted a retrospective analysis of data collected from UC patients enrolled in an ongoing prospective cohort study. Mucosal healing was defined as Mayo endoscopic score = 0. RESULTS: A total of 131 patients with ulcerative colitis were enrolled in our study and were prospectively followed for a median length of 2 years (range 0-5 years), totaling 266 study visits. Mucosal healing was recorded for 27 patients at 70 (26%) different study visits. For patients with mucosal healing, histologic remission was achieved in 18/27 (66%) patients. On univariate analysis, sustained clinical remission, SIBDQ scores ≥ 5.5, CRP ≤ 5 mg/dL and absence of corticotherapy were associated with mucosal healing and SIBDQ scores ≥ 5.5 and CRP ≤ 5 mg/dL with histologic healing, respectively. After logistic regression analysis, none of the investigated factors were associated with mucosal and histologic healing. The number of CD8+ intraepithelial lymphocytes (IELs) was significantly greater than the number of CD4+ IELs in periods of disease activity, as well as during mucosal healing ( < 0.01 in both cases). CONCLUSIONS: Mucosal healing and histologic remission rates are low in real-life settings. The results of univariate analysis indicate that a good quality of life (SIBDQ score) and normal inflammatory markers (CRP) are associated with mucosal and histologic healing. However, frequently used patient- and disease-related factors, including mucosal healing, are not reliable predictors for histologic remission. Greater CD8+ lymphocyte involvement and higher CD8+/CD4+ distribution can have a meaningful impact on understanding the pathogenesis and natural history of ulcerative colitis, as well as future treatment options for lymphocyte-targeting medications.
背景：组织学活性已成为溃疡性结肠炎治疗中的一个理想目标。它尚未成为溃疡性结肠炎的正式治疗靶点。然而，它可作为黏膜愈合的辅助指标，以代表更深层次的愈合。我们在一组溃疡性结肠炎患者中研究了黏膜和组织学缓解率以及这些结果的潜在预测因素。 方法：我们对从一项正在进行的前瞻性队列研究中纳入的溃疡性结肠炎患者收集的数据进行了回顾性分析。黏膜愈合定义为梅奥内镜评分=0。 结果：共有131例溃疡性结肠炎患者纳入我们的研究，并进行了前瞻性随访，中位随访时间为2年（范围0 - 5年），共进行了266次研究访视。在70次（26%）不同的研究访视中，有27例患者记录到黏膜愈合。对于黏膜愈合的患者，18/27（66%）例患者实现了组织学缓解。单因素分析显示，持续临床缓解、SIBDQ评分≥5.5、CRP≤5mg/dL以及未使用皮质类固醇治疗分别与黏膜愈合相关，而SIBDQ评分≥5.5和CRP≤5mg/dL与组织学愈合相关。经过逻辑回归分析，所研究的因素均与黏膜和组织学愈合无关。在疾病活动期以及黏膜愈合期间，CD8 + 上皮内淋巴细胞（IELs）的数量均显著多于CD4 + IELs的数量（两种情况均P<0.01）。 结论：在现实生活中，黏膜愈合和组织学缓解率较低。单因素分析结果表明，良好的生活质量（SIBDQ评分）和正常的炎症标志物（CRP）与黏膜和组织学愈合相关。然而，包括黏膜愈合在内的常用患者和疾病相关因素并非组织学缓解的可靠预测指标。更多的CD8 +淋巴细胞参与以及更高的CD8 + /CD4 + 分布可能对理解溃疡性结肠炎的发病机制和自然史以及未来针对淋巴细胞的药物治疗选择产生有意义的影响。
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