A Noninvasive Method to Assess Mucosal Healing in Patients* With Crohn's Disease.
A Noninvasive Method to Assess Mucosal Healing in Patients* With Crohn's Disease.
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发表时间：
2018-05
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通讯作者：
W. Sandborn;M. Abreu;M. Dubinsky
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作者：
W. Sandborn;M. Abreu;M. Dubinsky
胃肠道持续的炎症和粘膜屏障的丧失是克罗恩病的关键组成部分。目前的治疗模式，包括靶向治疗，都是基于临床和内窥镜症状的改善。内窥镜是评估粘膜愈合的重要工具，但患者可能不愿重复手术。炎症的替代标记物，如C-反应蛋白和粪便钙保护素，正在被使用，但它们在评估粘膜愈合方面有几个局限性。一种名为莫尼诺试验的新方法，通过评估克罗恩病患者血清13个生物标记物的水平来评估粘膜愈合状态。这13个生物标志物与细胞黏附、炎症、血管生成、细胞外基质重塑、细胞增殖和修复以及免疫细胞募集有关。Monitr检测产生一个反映疾病严重程度的粘膜愈合指数评分。该测试的验证显示，对于内窥镜检查有克罗恩病证据的患者，总体准确率为90%，阴性预测值为92%，阳性预测值为87%。使用这种非侵入性测试可能有助于对克罗恩病患者的监测和管理，同时潜在地减少重复内窥镜检查的需要。
Ongoing inflammation in the gastrointestinal tract and loss of the mucosal barrier are key components of Crohn's disease. Current treatment paradigms, including treat-to-target, are based on improvement of both clinical and endoscopic symptoms. Endoscopy is an essential tool for the evaluation of mucosal healing, but patients may be reluctant to undergo repeated procedures. Surrogate markers of inflammation, such as C-reactive protein and fecal calprotectin, are being used, yet they have several limitations in the assessment of mucosal healing. A new strategy, known as the Monitr test, assesses mucosal healing status by evaluating serum levels of 13 biomarkers in patients with Crohn's disease. The 13 biomarkers are associated with cell adhesion, inflammation, angiogenesis, extracellular matrix remodeling, cell proliferation and repair, and immune cell recruitment. Monitr testing yields a mucosal healing index score that reflects disease severity. Validation of the test showed an overall accuracy of 90%, with a negative predictive value of 92% and a positive predictive value of 87% for identifying patients with endoscopic evidence of Crohn's disease. Use of this noninvasive test may aid in the monitoring and management of patients with Crohn's disease, while potentially reducing the need for repeated endoscopy.