Mucosal healing in inflammatory bowel disease: Results from a Norwegian population-based cohort
Mucosal healing in inflammatory bowel disease: Results from a Norwegian population-based cohort
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DOI：
10.1053/j.gastro.2007.05.051
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发表时间：
2007-08-01
期刊：
影响因子：
29.4
通讯作者：
Vatn, Morten H.
中科院分区：
文献类型：
--
作者：
Froslie, Kathrine Frey;Jahnsen, Jorgen;Vatn, Morten H.
背景和目标：炎症性肠病的粘膜愈合（MH）可能是治疗有效性的重要标志和长期疾病的预后标志。该研究的目的是检查粘膜愈合的可能预测因素以及愈合对后续病程的影响。研究方法：在1990年至1994年（生物治疗可用之前）诊断为溃疡性结肠炎（UC）或克罗恩病（CD）的740例事件患者中，记录了人口统计学和症状。在治疗前的基线进行了临床和内镜评价，并在495例患者中进行了1年和5年后的重复评价。结果如下：在UC患者中，超过12年的教育和诊断时广泛的疾病是1年后MH的重要预测因素（分别校正P =.004和P = .02）。MH与未来结肠切除术的低风险显著相关（P = 0.02）。在CD患者中，诊断时发热和未使用类固醇的药物治疗是MH的重要预测因素（分别校正P = .03和P = .01）。MH与5年后炎症减少（P = .02），未来类固醇治疗减少（P =.02）显著相关。结论：几个因素预测随后的MH。教育程度作为预测因子可能暗示了应对、依从性或生活方式的重要性。治疗1年后的MH预示着随后的疾病活动减少，对积极治疗的需求减少。目前的结果进一步加强了粘膜愈合作为炎症性肠病的临床指标和治疗目标的作用。
Background&Aims: Mucosal healing (MH) in inflammatory bowel disease may be an important sign of efficacy of treatment and a prognostic marker of long-term disease. The aim of the study was to examine both the possible predictors of mucosal healing and the impact of healing on subsequent course of disease. Methods: In 740 incident patients diagnosed with ulcerative colitis (UC) or Crohn's disease (CD) between 1990 and 1994 (before biologic therapy was available), demographics and symptoms were recorded. Clinical and endoscopic evaluations were done at baseline before treatment and repeated after 1 and 5 years in 495 patients. Results: In UC patients, education longer than 12 years and extensive disease at diagnosis were significant predictors of MH after 1 year (adjusted P =.004 and P = .02, respectively). MH was significantly associated with a low risk of future colectomy (P = .02). In patients with CD, fever at diagnosis and medical treatment without steroids were significant predictors for MH (adjusted P = .03 and P = .01, respectively). MH was significantly associated with less inflammation after 5 years (P = .02), decreased future steroid treatment (P =.02). Conclusions: Several factors predicted subsequent MH. Education as predictor may implicate the importance of coping, compliance, or lifestyle. MH after 1 year of treatment is predictive of reduced subsequent disease activity and decreased need for active treatment. The present results give further strength to the use of mucosal healing as a clinical indicator and treatment goal in inflammatory bowel disease.