The prognostic value of histology in ulcerative colitis in clinical remission with mesalazine
The prognostic value of histology in ulcerative colitis in clinical remission with mesalazine
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DOI：
10.1177/1756283x17722926
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发表时间：
2017-10-01
影响因子：
4.2
通讯作者：
Viscido, Angelo
中科院分区：
文献类型：
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作者：
Frieri, Giuseppe;Galletti, Brigida;Viscido, Angelo
背景：该研究的目的是比较溃疡性结肠炎(UC)患者的组织学和内窥镜活动对预后的价值。方法：临床缓解1年的患者接受有计划的结肠镜检查和活检。用组织学活动指数(HAI)对组织学活动进行评分。使用Mayo内窥镜评分(MES)对内窥镜活动进行评分。对临床病程进行评估，测量在3年随访期间使用类固醇的复发率。结果：共有52名患者入选研究并随访3年。基线时，29名患者(55.77%)无内窥镜损伤，17名患者(32.69%)无组织学改变。在3年的随访中，总共有26名患者(50%)仍处于非类固醇缓解状态。单因素Logistic回归分析显示，组织学(HAI 1)和胃镜活动(MES>；1)与预后显著相关，分别显示复发风险(优势比[OR])是组织学缓解(HAI 0)的16.4倍(96%可信区间[CI]：3.2-84.3)和胃镜缓解(MES 0)的6.3倍(96%CI：1.9-21.3)。经多因素Logistic回归分析，组织学活动是唯一与预后显著相关的因素(OR 10.2；95%CI：1.7~59.4)。结论：组织学活动对预测美沙拉秦临床缓解期UC患者是否需要激素有最强的预后价值。可作为UC治疗的靶点。
Background: The aim of the study was to compare the prognostic value of histological and endoscopic activity in patients with ulcerative colitis (UC).Methods: Patients in clinical remission for 1 year under treatment with mesalazine underwent a planned colonoscopy with biopsies. Histological activity was scored using the histological activity index (HAI). Endoscopic activity was scored using the Mayo endoscopic subscore (MES). The clinical course was evaluated measuring relapses needing steroids during a follow up of 3 years.Results: A total of 52 patients were enrolled into the study and followed up for 3 years. At baseline 29 patients (55.77%) had no endoscopic lesions, and 17 patients (32.69%) showed no histological alteration. At 3 years of follow up, overall, 26 patients (50%) were still in steroid-free remission. Using univariate logistic regression analysis, both histological (HAI 1) and endoscopic activity (MES > 1) were significantly associated with outcome, showing, respectively, a relapse risk (odds ratio [OR]) 16.4 times higher than histological remission (HAI 0) (96% confidence interval [CI]: 3.2-84.3) and 6.3 times higher with respect to endoscopic remission (MES 0) (96% CI: 1.9-21.3). After multivariate logistic regression analysis, histological activity was the only factor significantly associated with outcome (OR 10.2; 95% CI: 1.7-59.4).Conclusions: Histological activity has the most powerful prognostic value in predicting the need for steroids in patients with UC in stable clinical remission on mesalazine. It could be considered as a target of therapy in UC.