组织学炎症可预测内镜缓解期溃疡性结肠炎患者未来的临床复发。
Histologic Inflammation can Predict Future Clinical Relapse in Ulcerative Colitis Patients in Endoscopic Remission.
作者信息
George Lauren A, Feldman Harris T, Alizadeh Madeline, Abutaleb Ameer, Zullow Samantha, Hine Ashley, Stashek Kristen, Sarkar Suparna, Sun Katherine, Hudesman David, Axelrad Jordan, Cross Raymond K
机构信息
Division of Gastroenterology and Hepatology, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
Department of Medicine, Department of Pediatrics, University of Massachusetts Medical School, Worcester, MA, USA.
出版信息
Crohns Colitis 360. 2023 Oct 18;5(4):otad059. doi: 10.1093/crocol/otad059. eCollection 2023 Oct.
BACKGROUND
In ulcerative colitis (UC), endoscopic improvement, defined as a Mayo Endoscopic Score (MES) of 0 or 1, is a target of treatment. The aim of our study was to evaluate the risk of clinical relapse between patients with an MES of 0 or 1 and determine if histologic activity using the Robarts Histopathologic Index (RHI) was predictive of clinical relapse.
METHODS
UC patients with an MES score of 0 or 1, no prior colectomy, and at least 1 year of outpatient follow-up after colonoscopy were included. Demographic, clinical characteristics, and clinical relapse were retrospectively collected. Biopsy specimens were read by a gastrointestinal pathologist. Primary outcome was defined as a composite of relapse requiring change in medical therapy, new steroid use, UC-related hospitalization, and/or colectomy.
RESULTS
Four hundred and forty-five UC patients were identified. Ninety-five percent of patients with MES 0 were in histologic remission by the RHI whereas only 35% of patients with MES 1 were in histologic remission. Twenty-six percent of patients experienced a clinical relapse; patients with MES 1 or RHI > 3 were significantly more likely to relapse ( < .01) compared to patients with MES 0 or RHI ≤ 3. When patients were stratified into 4 groups (MES 0, RHI ≤ 3; MES 0, RHI > 3; MES 1, RHI ≤ 3; MES 1, RHI > 3) and adjusted for age and sex, RHI > 3 was predictive of relapse ( = .008).
CONCLUSIONS
UC patients with endoscopic improvement have a high rate of clinical relapse over time. Histologic activity is a predictor of clinical relapse.
背景
在溃疡性结肠炎（UC）中，内镜改善定义为梅奥内镜评分（MES）为0或1，是治疗的目标。我们研究的目的是评估MES为0或1的患者临床复发的风险，并确定使用罗伯茨组织病理学指数（RHI）的组织学活性是否可预测临床复发。
方法
纳入MES评分为0或1、未行过结肠切除术且结肠镜检查后至少有1年门诊随访的UC患者。回顾性收集人口统计学、临床特征和临床复发情况。活检标本由胃肠病理学家阅片。主要结局定义为需要改变药物治疗、使用新的类固醇、因UC住院和/或行结肠切除术的复发综合情况。
结果
共确定445例UC患者。MES为0的患者中有95%经RHI评估处于组织学缓解，而MES为1的患者中只有35%处于组织学缓解。26%的患者经历了临床复发；与MES为0或RHI≤3的患者相比，MES为1或RHI>3的患者复发的可能性显著更高（P<0.01）。当将患者分为四组（MES为0，RHI≤3；MES为0，RHI>3；MES为1，RHI≤3；MES为1，RHI>3）并根据年龄和性别进行调整后，RHI>3可预测复发（P=0.008）。
结论
内镜改善的UC患者随着时间推移临床复发率较高。组织学活性是临床复发的一个预测因素。
Zotero 插件