基于磁共振肠造影术实现透壁愈合的克罗恩病患者的长期结局及相关因素：一项中国回顾性队列研究
Long-term outcomes and associated factors of Crohn's disease patients achieving transmural healing based on magnetic resonance enterography: a Chinese retrospective cohort study.
作者信息
Lu Yaming, Xiong Shanshan, Zhang Mengchen, Zu Xiaoman, Li Jinbin, Mao Ren, Zeng Zhirong, Li Xuehua, Chen Minhu, He Yao
机构信息
Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
Department of Radiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
出版信息
Ther Adv Chronic Dis. 2024 Jul 24;15:20406223241259654. doi: 10.1177/20406223241259654. eCollection 2024.
BACKGROUND
Transmural healing (TH) has emerged as a potential treatment goal for Crohn's disease (CD). However, further research is needed to confirm its benefits and risk factors associated with TH remain unclear.
OBJECTIVES
We aimed to assess the value of TH based on magnetic resonance enterography (MRE) in Chinese CD patients regarding the long-term outcomes and its associated factors.
DESIGN
Retrospective, observational cohort study.
METHODS
Patients with CD diagnosed by colonoscopy and MRE examination between 2015 and 2022 were included. All patients were evaluated with endoscopy together with MRE within 6-12 months after baseline and followed up for at least 6 months after evaluation. The primary endpoint was the occurrence of major outcomes during the follow-up, including drug escalation, hospitalization, and surgery. The cumulative probabilities of major outcomes were calculated using Kaplan-Meier survival curves. Logistic regression analyses were used to predict TH within 6-12 months after baseline.
RESULTS
A total of 175 patients were included in the study. Of these, 69 (39.4%) patients achieved mucosal healing (MH), but only 34 (19.4%) of them achieved TH. The median follow-up duration was 17.4 months (interquartile range, 11.6-25.5), and major outcomes occurred in 58.3% of patients. A lower occurrence rate of major outcomes was noted in patients who achieved TH than in those who achieved MH only ( = 0.012). The baseline lymphocyte/C-reactive protein ratio (LCR) [odds ratio (OR), 1.60; 95% confidence interval (CI), 1.02-2.50; = 0.039] and bowel wall thickness (BWT) (OR, 0.72; 95% CI, 0.59-0.90; = 0.003) were independent predictors associated with TH. According to multivariate Cox regression analysis, low LCR [hazard ratio (HR), 2.34; 95% CI, 1.51-3.64; < 0.001], and no healing (HR, 5.45; 95% CI, 2.28-13.00; < 0.001) were associated with an increased risk of major outcomes.
CONCLUSION
Patients with CD who achieved TH showed improved prognosis compared to those who achieved MH only. Baseline LCR and BWT might predict TH.
背景
透壁愈合（TH）已成为克罗恩病（CD）潜在的治疗目标。然而，需要进一步研究以证实其益处，且与TH相关的风险因素仍不明确。
目的
我们旨在评估基于磁共振小肠造影（MRE）的TH在中国CD患者中的长期结局价值及其相关因素。
设计
回顾性观察队列研究。
方法
纳入2015年至2022年间经结肠镜检查和MRE检查确诊的CD患者。所有患者在基线后6 - 12个月内接受内镜检查及MRE评估，并在评估后至少随访6个月。主要终点是随访期间主要结局的发生情况，包括药物升级、住院和手术。使用Kaplan-Meier生存曲线计算主要结局的累积概率。采用逻辑回归分析预测基线后6 - 12个月内的TH情况。
结果
本研究共纳入175例患者。其中，69例（39.4%）患者实现黏膜愈合（MH），但仅34例（19.4%）实现TH。中位随访时间为17.4个月（四分位间距，11.6 - 25.5），58.3%的患者出现主要结局。实现TH的患者主要结局发生率低于仅实现MH的患者（P = 0.012）。基线淋巴细胞/C反应蛋白比值（LCR）[比值比（OR），1.60；95%置信区间（CI），1.02 - 2.50；P = 0.039]和肠壁厚度（BWT）（OR，0.72；95% CI，0.59 - 0.90；P = 0.003）是与TH相关的独立预测因素。根据多变量Cox回归分析，低LCR[风险比（HR），2.34；95% CI，1.51 - 3.64；P < 0.001]和未愈合（HR，5.45；95% CI，2.28 - 13.00；P < 0.001）与主要结局风险增加相关。
结论
与仅实现MH的CD患者相比，实现TH的患者预后改善。基线LCR和BWT可能预测TH。
Zotero 插件