Predictors and outcomes of histological remission in ulcerative colitis treated to endoscopic healing.
Predictors and outcomes of histological remission in ulcerative colitis treated to endoscopic healing.
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DOI：
10.1111/apt.16026
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发表时间：
2020-09
影响因子：
7.6
通讯作者：
Singh S
中科院分区：
文献类型：
--
作者：
Jangi S;Yoon H;Dulai PS;Valasek M;Boland BS;Jairath V;Feagan BG;Sandborn WJ;Singh S
临床缓解是溃疡性结肠炎的推荐治疗目标。在目标治疗范式中实现组织学缓解的预测因素和结果尚未明确。我们评估了接受内镜愈合目标治疗的溃疡性结肠炎患者实现组织学缓解的预测因素和结果（改良梅奥内镜评分 0 或 1）。我们对患有活动性溃疡性结肠炎的成人（改良梅奥内窥镜评分 2 或 3）进行了一项回顾性队列研究，其治疗经过迭代优化以实现内镜愈合。我们使用 Cox 比例风险分析确定了实现组织学缓解的预测因素，以及实现组织学缓解与持续组织学活动的结果（症状复发的风险、溃疡性结肠炎相关的住院和/或手术）。在 411 名临床活动性溃疡性结肠炎患者中，270 名患者实现内镜治愈。在 270 名患者中，55% 同时达到组织学缓解。最终内镜评估时内镜愈合的深度是组织学缓解的唯一独立决定因素（改良梅奥内镜评分 0 与 1：比值比，0.31 [95% 置信区间，0.18-0.52]）。 28 个月内，实现组织学缓解与临床复发风险较低（1 年累积风险：18.7% 对比 29.5%；调整后风险比，0.56 [0.37–0.85]）和住院风险较低（风险比，0.44 [0.20–0.94]）相关。仅在梅奥内窥镜评分为 1 的患者中观察到实现组织学缓解的增量益处，但在梅奥内镜评分为 0 的患者中观察不到。在达到内镜愈合目标的活动性溃疡性结肠炎患者中，55% 同时实现组织学缓解。组织学缓解，尤其是达到改良梅奥内窥镜评分 1 分的患者，与良好的结果相关。治疗内镜下愈合的组织学缓解目标需要前瞻性评估。
Clinical remission is the recommended treatment target in ulcerative colitis. The predictors and outcomes of achieving histologic remission within a treat-to-target paradigm are not well established. We evaluated the predictors and outcomes of achieving histologic remission in patients with ulcerative colitis treated-to-target of endoscopic healing (modified Mayo endoscopy score 0 or 1). We conducted a retrospective cohort study in adults with active ulcerative colitis (modified Mayo endoscopy score 2 or 3), whose treatment was iteratively optimized to achieve endoscopic healing. We identified predictors of achieving histologic remission, and outcomes (risk of symptomatic relapse, and ulcerative colitis-related hospitalization and/or surgery) of achieving histologic remission vs. persistent histologic activity, using Cox proportional hazard analysis. Of 411 patients with clinically active ulcerative colitis, 270 patients achieved endoscopic healing. Of 270 patients, 55% simultaneously achieved histologic remission. Depth of endoscopic healing at final endoscopic assessment was the only independent determinant of histologic remission (modified Mayo endoscopy score 0 vs. 1: odds ratio, 0.31 [95% confidence intervals, 0.18–0.52]). Over 28 months, achieving histologic remission was associated with a lower risk of clinical relapse (1-year cumulative risk: 18.7% vs 29.5%; adjusted hazard ratio, 0.56 [0.37–0.85]), and lower risk of hospitalizations (hazard ratio, 0.44 [0.20–0.94]). The incremental benefit of achieving histologic remission was observed only in patients achieving Mayo endoscopy score 1, but not Mayo endoscopy score 0. In patients with active ulcerative colitis treated-to-target of endoscopic healing, 55% simultaneously achieve histologic remission. Histologic remission, particularly in patients achieving modified Mayo endoscopy score 1, was associated with favorable outcomes. Treating to a target of histologic remission over endoscopic healing requires prospective evaluation.
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影响因子：
24.5
作者：
Marchal-Bressenot, Aude;Salleron, Julia;Peyrin-Biroulet, Laurent
通讯作者：
Peyrin-Biroulet, Laurent
影响因子：
1.9
作者：
Kim, Jae Hyun;Cheon, Jae Hee;Kim, Won Ho
通讯作者：
Kim, Won Ho
影响因子：
24.5
作者：
Geboes, K;Riddell, R;Löfberg, R
通讯作者：
Löfberg, R
影响因子：
2.6
作者：
Kanazawa, Mimari;Takahashi, Fumiaki;Irisawa, Atsushi
通讯作者：
Irisawa, Atsushi
影响因子：
1.9
作者：
LANDIS, JR;KOCH, GG
通讯作者：
KOCH, GG