Histologic Healing Is More Strongly Associated with Clinical Outcomes in Ileal Crohn's Disease than Endoscopic Healing.
Histologic Healing Is More Strongly Associated with Clinical Outcomes in Ileal Crohn's Disease than Endoscopic Healing.
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DOI：
10.1016/j.cgh.2019.11.056
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发表时间：
2020-10
期刊：
影响因子：
--
通讯作者：
Rubin DT
中科院分区：
文献类型：
--
作者：
Christensen B;Erlich J;Gibson PR;Turner JR;Hart J;Rubin DT
深度缓解是克罗恩病(CD)内科治疗的目标，其基础是临床缓解和内窥镜检查期间愈合的证据。我们调查了组织学愈合是否与CD回肠炎患者的预后有关。我们对2005年9月至2015年6月间行结肠镜检查的101名回肠末端分离的CD患者(男性占52%)进行了回顾性研究。我们的分析包括在结肠镜检查中临床缓解的患者，他们接受了结肠和回肠的活检。评估回肠的内窥镜愈合情况(无溃疡)和愈合的组织学证据(无活动性炎症、侵蚀、溃疡或中性粒细胞渗入)。我们比较了有和没有组织学和内窥镜治愈的患者的临床无复发生存时间、药物升级、皮质类固醇的使用或因疾病活动继发住院的时间，平均随访时间为21个月。我们使用Kaplan Meier分析和Cox比例风险模型确定了与生存相关的因素。在回肠结肠镜检查中，63%的患者在内窥镜下愈合，55%的患者有愈合的组织学证据。内窥镜和组织学活动之间的符合率为62%(K=0.2250，P=0.0064)。42名患者临床复发，45名患者用药升级，30名患者需要皮质类固醇，17名患者住院(3名患者需要手术)。在多变量分析中，只有组织学愈合与降低临床复发风险(风险比[HR]，2.05；95%CI，1.07-3.94；P=.031)、药物升级(HR，2.17；95%CI，1.2-3.96；P=.011)和使用皮质类固醇(HR，2.44；95%CI，1.17-5.09；P=.018)相关。没有与住院有关的因素。在临床缓解的回肠CD患者中，组织学愈合而不是内窥镜愈合与临床复发、药物升级或皮质类固醇使用的风险降低相关。
Deep remission, based on clinical remission and evidence of healing during endoscopic evaluation, are goals of medical treatments for Crohn’s disease (CD). We investigated whether histologic healing is associated with outcomes of patients with CD ileitis. We performed a retrospective study of 101 patients with CD (52% male) isolated to the terminal ileum who had a colonoscopy between September 2005 and June 2015. Our analysis included patients in clinical remission at colonoscopy who had biopsies collected from colon and ileum. The ileum was evaluated for endoscopic healing (no ulceration) and histologic evidence of healing (no active inflammation, erosions, ulceration, or neutrophil infiltration). We compared times of clinical relapse-free survival, medication escalation, corticosteroid use, or hospitalization secondary to disease activity between patients with and without histological and endoscopic healing, followed for a median 21 months. We identified factors associated with survival using Kaplan Meier analysis and Cox proportional hazard model. At ileo-colonoscopy, 63% of patients had endoscopic healing and 55% had histologic evidence of healing. The level of agreement between endoscopic and histologic activity was fair (62%, K=0.2250, P=.0064). Forty-two patients had clinical relapse, 45 had medication escalation, 30 required corticosteroids, and 17 were hospitalized (3 required surgery). On multivariate analysis, only histologic healing was associated with decreased risk of clinical relapse (hazard ratio [HR], 2.05; 95% CI, 1.07–3.94; P=.031), medication escalation (HR, 2.17; 95% CI, 1.2–3.96; P=.011), and corticosteroid use (HR, 2.44; 95% CI, 1.17–5.09; P=.018). No factors were associated with hospitalization. In patients with ileal CD in clinical remission, histologic healing but not endoscopic healing is associated with decreased risk of clinical relapse, medication escalation, or corticosteroid use.
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