Bowel Damage in Patients With Long-term Crohn's Disease, Assessed by Magnetic Resonance Enterography and the Lemann Index
Bowel Damage in Patients With Long-term Crohn's Disease, Assessed by Magnetic Resonance Enterography and the Lemann Index
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DOI：
10.1016/j.cgh.2017.06.053
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发表时间：
2018-01-01
影响因子：
12.6
通讯作者：
Negard, Anne
中科院分区：
文献类型：
--
作者：
Lunder, Aida Kapic;Jahnsen, Jorgen;Negard, Anne
背景与目的：磁共振小肠成像（MRE）用于评估克罗恩病（CD）的范围和并发症。MRE结果用于计算Lemann指数（LI）评分，该评分可量化肠损伤。CD的长期结果是不确定的，我们的目的是评估肠道疾病和损害的CD患者20年使用MRE和LI.METHODS：我们进行了一项随访分析的人口为基础的队列237例患者在挪威东南部诊断CD从1990年至1993年。诊断20年后，156人参加了评估，其中他们接受了常规临床血液检查和结肠镜检查。对96例患者进行MRE检查并计算LI评分。LI评分与临床变量的独立关联进行了检查，通过单变量analysis.Results：65例患者（67.7%）CD表现的基础上，从MRE（36.9%），结肠镜检查（29.2%），或两者兼而有之（33.9%）的结果。MRE结果改变了8例患者（8.3%）的疾病分类。中位LI评分为4.6（四分位距，17.5），与年轻（P = 0.02）、复杂的回结肠表型（P <0.001）、生物制剂（P <0.001）或免疫抑制剂治疗（P = 0.045）相关。在随访期间与LI评分独立相关的因素是年龄，复杂的疾病，药物的使用，和炎症标志物。结论：在一项以人群为基础的研究，237例CD患者在挪威，我们发现，近68%的CD的成像功能，其中一半只能检测到的MRE。LI评分与正在进行的活动性疾病相关。年龄小、病情复杂、持续性炎症与肠损害有关。
BACKGROUND & AIMS: Magnetic resonance enterography (MRE) is used to evaluate the extent and complications of Crohn's disease (CD). MRE results are used in calculation of the Lemann index (LI) score, which quantifies bowel damage. The long-term outcomes of CD are uncertain; we aimed to assess bowel disease and damage in patients with CD for 20 years using MRE and the LI.METHODS: We performed a follow-up analysis of a population-based cohort of 237 patients in southeastern Norway diagnosed with CD from 1990 to 1993. Twenty years after diagnosis, 156 attended the evaluation in which they were offered routine clinical blood tests and colonoscopies. Ninety-six patients were examined by MRE and LI scores were calculated. The independent association of the LI score with clinical variables was examined by univariate analysis.RESULTS: Sixty-five patients (67.7%) had CD manifestations based on findings from MRE (36.9%), colonoscopy (29.2%), or both (33.9%). MRE findings changed disease classification for 8 patients (8.3%). The median LI score was 4.6 (interquartile range, 17.5) and associated with younger age (P = .02), complicated ileocolonic phenotype (P < .001), and use of biologic (P < .001), or immunosuppressant therapies (P = .045). Factors independently associated with LI score during the follow-up period were age, complicated disease, use of medication, and markers of inflammation.CONCLUSIONS: In a population-based study of 237 patients with CD in Norway, we found that almost 68% had imaging features of CD, half of which were only detectable by MRE. LI score associated with ongoing active disease. Young age, complicated disease, and persistent inflammation were associated with bowel damage.