Factors associated with the achievement of mucosal healing in Crohn's disease: the benefit of endoscopic monitoring in treating to target.
Factors associated with the achievement of mucosal healing in Crohn's disease: the benefit of endoscopic monitoring in treating to target.
复制标题
与克罗恩病粘膜愈合相关的因素：内窥镜监测在目标治疗中的益处。
DOI：
10.1177/1756283x17698089
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发表时间：
2017-06
影响因子：
4.2
通讯作者：
Chen MH
中科院分区：
文献类型：
--
作者：
Mao R;Qiu Y;Chen BL;Zhang SH;Feng R;He Y;Zeng ZR;Ben-Horin S;Chen MH
粘膜愈合(MH)是克罗恩病(CD)的靶向治疗方法，与改善疾病预后有关。在临床实践中，与获得MH相关的因素的数据仍然很少。我们评估了CD患者发生MH的可能性，并确定了预测继发MH的因素。这是一项回溯性的观察性队列研究。共272例CD患者接受了一系列的内窥镜检查和随后的治疗。主要结果是MH。使用Kaplan-Meier方法评估MH的累积发生率和内窥镜改善情况。使用Cox比例风险模型确定与MH独立相关的因素。在272例患者中，126例(46.32%)在中位随访期33个月(四分位数范围：27-38个月)后发生MH。经多因素分析，与MH独立相关的因素有：内窥镜手术间隔26周内的时间(风险比：1.56；95%可信区间：1.05-3.39)，未达到MH时调整药物治疗(HR：2.07；95%CI：1.26-2.33)，既往肠瘘(HR：0.22；95%CI：0.06-0.91)，CD诊断时的肛周疾病(HR：0.58；C反应蛋白在12周内恢复正常(HR：3.23；95%CI：1.82~5.88)。类似的因素也被确定为内窥镜检查的改进。每隔26周进行一次连续的内窥镜检查和随后的内科治疗调整有助于获得MH。内窥镜监测在CD靶向治疗中起着重要作用。
Mucosal healing (MH), the proposed treat to target in Crohn’s disease (CD), is associated with improved disease outcomes. There are still scant data on factors associated with achieving MH in clinical practice. We evaluated the probability of achieving MH and identified factors predictive of subsequent MH in patients with CD. This was a retrospective, observational cohort study. A total of 272 patients with CD with serial endoscopy assessment and subsequent therapeutic management were reviewed. The primary outcome was MH. The cumulative incidence of MH and endoscopic improvement was estimated using the Kaplan–Meier method. Factors independently associated with MH were identified using the Cox proportional hazards model. Of the 272 patients, 126 (46.32%) achieved MH after a median follow-up period of 33 months (interquartile range: 27–38 months). Factors independently associated with MH by multivariate analysis were time between endoscopic procedures within 26 weeks (hazard ratio [HR]: 1.56; 95% confidence interval [CI]: 1.05–3.39), adjustment of medical therapy when MH was not achieved (HR: 2.07; 95% CI: 1.26–2.33), prior enteric fistula (HR: 0.22; 95% CI: 0.06–0.91), perianal disease at CD diagnosis (HR: 0.58; 95% CI: 0.35–0.95), and C-reactive protein normalization within 12 weeks (HR: 3.23; 95% CI: 1.82–5.88). Similar factors have also been identified for endoscopic improvement. Performing serial endoscopic procedures at a 26-week interval and subsequent adjustment in medical treatment are helpful in achieving MH. Endoscopic monitoring plays an important role in the treating to target of CD.