Cumulative burden of inflammation predicts colorectal neoplasia risk in ulcerative colitis: a large single-centre study.
Cumulative burden of inflammation predicts colorectal neoplasia risk in ulcerative colitis: a large single-centre study.
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DOI：
10.1136/gutjnl-2017-314190
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发表时间：
2019-03
期刊：
影响因子：
24.5
通讯作者：
Hart AL
中科院分区：
文献类型：
--
作者：
Choi CR;Al Bakir I;Ding NJ;Lee GH;Askari A;Warusavitarne J;Moorghen M;Humphries A;Ignjatovic-Wilson A;Thomas-Gibson S;Saunders BP;Rutter MD;Graham TA;Hart AL
溃疡性结肠炎(UC)是一种动态变化的疾病，其严重程度随着时间的推移而不断变化。我们假设UC的大肠肿瘤(CRN)风险与精算累积性炎症负担密切相关，而目前的风险分层策略不能充分反映这一点。这是一项回溯性的单中心研究。研究对象为2003-2012年间接受结肠镜检查的广泛性UC患者。每个监测事件根据显微镜炎症的严重程度进行评分(0=无活动；1=轻度；2=中度；3=重度活动)。累计炎症负担(CIB)被定义为：每对监测事件之间的平均得分乘以监测间隔数年。使用时间依赖的COX回归分析，潜在的预测因素与CRN的预后相关。共有987名患者被随访13年(IQR，9-18年)，其中97名(9.8%)发展为CRN。多因素分析显示，慢性肾小球疾病的发生与慢性肾小球肾炎的发生显著相关(HR，相当于10、5或3.3年连续轻度、中度或重度活动性显微镜炎症)；95%可信区间为1.4~3.0；P<；0.001)。反映这一点的是，虽然仅基于最近一次结肠镜检查的炎症严重程度并不显著(HR，每单位增加0.9%；95%可信区间0.7%至1.2%；P=0.5.5)，但根据之前5年进行的所有结肠镜检查计算的平均严重程度评分与慢性肾炎风险显著相关(HR，每单位增加2.2%；95%可信区间1.6%至3.1%；P<；0.001)。UC发生CRN的风险与累积性炎症负担显著相关。准确的CRN风险分层应包括对多个监测事件的评估，以考虑这一点。
Ulcerative colitis (UC) is a dynamic disease with its severity continuously changing over time. We hypothesised that the risk of colorectal neoplasia (CRN) in UC closely follows an actuarial accumulative inflammatory burden, which is inadequately represented by current risk stratification strategies. This was a retrospective single-centre study. Patients with extensive UC who were under colonoscopic surveillance between 2003 and 2012 were studied. Each surveillance episode was scored for a severity of microscopic inflammation (0=no activity; 1=mild; 2=moderate; 3=severe activity). The cumulative inflammatory burden (CIB) was defined as sum of: average score between each pair of surveillance episodes multiplied by the surveillance interval in years. Potential predictors were correlated with CRN outcome using time-dependent Cox regression. A total of 987 patients were followed for a median of 13 years (IQR, 9-18), 97 (9.8%) of whom developed CRN. Multivariate analysis showed that the CIB was significantly associated with CRN development (HR, 2.1 per 10-unit increase in CIB (equivalent of 10, 5 or 3.3 years of continuous mild, moderate or severe active microscopic inflammation); 95% CI 1.4 to 3.0; P<0.001). Reflecting this, while inflammation severity based on the most recent colonoscopy alone was not significant (HR, 0.9 per-1-unit increase in severity; 95% CI 0.7 to 1.2; P=0.5), a mean severity score calculated from all colonoscopies performed in preceding 5 years was significantly associated with CRN risk (HR, 2.2 per-1-unit increase; 95% CI 1.6 to 3.1; P<0.001). The risk of CRN in UC is significantly associated with accumulative inflammatory burden. An accurate CRN risk stratification should involve assessment of multiple surveillance episodes to take this into account.
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