中段小肠节段Lewis评分可预测静止期克罗恩病患者的长期预后。
Middle small-bowel segment Lewis score may predict long-term outcomes among patients with quiescent Crohn's disease.
作者信息
Ukashi Offir, Yablecovitch Doron, Lahat Adi, Selinger Limor, Neuman Sandra, Eliakim Rami, Ben-Horin Shomron, Kopylov Uri
机构信息
Gastroenterology Institute and Internal Medicine Department A, Sheba Medical Center, Tel HaShomer, Ha'ela 1, Ramat Gan 52621, Israel.
Gastroenterology Institute, Sheba Medical Center Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
出版信息
Therap Adv Gastroenterol. 2023 Jul 31;16:17562848231188587. doi: 10.1177/17562848231188587. eCollection 2023.
BACKGROUND
Video capsule endoscopy (VCE) has been proven to accurately diagnose small-bowel inflammation and predict flares among patients with quiescent Crohn's disease (CD). However, data regarding its predictive role in this population over an extended follow-up are scarce.
OBJECTIVES
To predict clinical exacerbation and to assess the yield of Lewis score in identifying CD patients with future clinical exacerbation during an extended follow-up (>24 months).
DESIGN
A analysis study.
METHODS
Adult patients with quiescent small-bowel CD who were followed with VCE, inflammatory biomarkers and magnetic resonance enterography in a prospective study (between 2013 and 2018). We extracted extended clinical data (up to April 2022). The primary composite outcome (i.e. clinical exacerbation) was defined as intestinal surgery, endoscopic dilation, CD-related admission, corticosteroid administration, or biological/immunomodulator treatment change during follow-up.
RESULTS
Of the 61 patients in the study [median age 29 (24-37) years, male 57.4%, biologic treatment 46.7%], 18 patients met the primary outcome during an extended follow-up [median 58.0 (34.5-93.0) months]. On univariable analysis, complicated [hazard ratio (HR) 7.348, = 0.002] and stricturing disease phenotype (HR 5.305, = 0.001) were associated with higher risk for clinical exacerbation during follow-up. A baseline VCE middle small-bowel segment Lewis score (midLS) ⩾ 135 identified patients with future exacerbation [AUC (area under the curve) 0.767, 95% confidence interval (CI) 0.633-0.902, = 0.001, HR 6.317, 93% negative predictive value], whereas the AUC of the conventional Lewis score was 0.734 (95% CI: 0.589-0.879, = 0.004). Sensitivity analysis restricted to patients with either complicated ( = 34) or stricturing ( = 26) disease phenotype revealed that midLS still predicted clinical exacerbation during follow-up (AUC 0.747/0.753, respectively), in these patients.
CONCLUSION
MidLS predicts treatment failure in quiescent CD patients (median follow-up of 5 years) independently of disease phenotype.
背景
视频胶囊内镜检查（VCE）已被证明可准确诊断小肠炎症，并预测静止期克罗恩病（CD）患者的病情复发。然而，关于其在这一人群中长期随访的预测作用的数据却很少。
目的
预测临床病情加重情况，并评估Lewis评分在识别长期随访（>24个月）期间未来会出现临床病情加重的CD患者中的效能。
设计
一项分析研究。
方法
在一项前瞻性研究（2013年至2018年）中，对患有静止期小肠CD的成年患者进行VCE、炎症生物标志物和磁共振小肠造影检查。我们提取了长期临床数据（截至2022年4月）。主要复合结局（即临床病情加重）定义为随访期间进行肠道手术、内镜扩张、因CD入院、使用皮质类固醇治疗或改变生物制剂/免疫调节剂治疗。
结果
该研究中的61例患者[中位年龄29（24 - 37）岁，男性占57.4%，接受生物治疗的占46.7%]，18例患者在长期随访期间[中位时间58.0（34.5 - 93.0）个月]达到主要结局。单因素分析显示，复杂性[风险比（HR）7.348，P = 0.002]和狭窄型疾病表型（HR 5.305，P = 0.001）与随访期间临床病情加重的较高风险相关。基线VCE中小肠段Lewis评分（midLS）⩾135可识别出未来会病情加重的患者[曲线下面积（AUC）0.767，95%置信区间（CI）0.633 - 0.902，P = 0.001，HR 6.317，阴性预测值93%]，而传统Lewis评分的AUC为0.734（95% CI：0.589 - 0.879，P = 0.004）。仅限于复杂性疾病（n = 34）或狭窄型疾病（n = 26）表型患者的敏感性分析显示，在这些患者中，midLS在随访期间仍可预测临床病情加重（AUC分别为0.747/0.753）。
结论
midLS可独立于疾病表型预测静止期CD患者（中位随访5年）的治疗失败情况。
Zotero 插件