Clin Gastroenterology H: 组织学上的愈合与回肠克罗恩病的临床结果更紧密

2020-09-23 MedSci原创 MedSci原创

在患有克罗恩病(CD)的患者中,持续的炎症会导致肠损伤,传统观念认为,CD的治疗旨在控制临床症状。

         在患有克罗恩病(CD)的患者中,持续的炎症会导致肠损伤,传统观念认为,CD的治疗旨在控制临床症状。但是,临床症状与内镜黏膜疾病活动的相关性很差,仅通过症状的缓解就无法改变CD的这种自然进程和累积性肠损伤。另一方面,粘膜愈合与更好的长期预后相关。达到粘膜愈合的患者住院和手术率较低,并且疾病临床发作的可能性较小。但是,组织学炎症可能在粘膜愈合的环境中也持续存在,因此,本项研究我们调查了组织学愈合是否与CD回肠炎患者的预后相关。

 

        研究人员对2005年9月至2015年6月间接受回肠镜检查的101例CD患者(男性占52%)进行了回顾性研究。研究人员评估了CD患者回肠的内镜愈合情况(无溃疡)和组织学变化(有无活动性炎症,糜烂,溃疡或中性粒细胞浸润)。最后研究人员比较了有无组织学和内镜下治愈的患者之间的无复发生存期,药物升级,使用皮质类固醇激素或因疾病活动而继发住院的时间,并使用Kaplan Meier分析和Cox比例风险模型确定了与生存相关的因素。

 

        回肠结肠镜检查时,有63%的患者有内镜愈合,有55%的组织学愈合。内镜和组织学活动之间的一致性水平是得到验证的(K = 0.2250,P = .0064)。42例患者出现临床复发,45例患者药物治疗逐步升级,30例需要皮质类固醇激素治疗,17例住院(3例需要手术治疗)。在多变量分析中,只有组织学治愈与临床复发风险降低相关(危险比[HR],2.05; 95%CI,1.07–3.94;P = .031),也与药物升级(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 )降低有关。

 

        最后,研究人员说道在临床缓解期有回肠CD的患者中,组织学治愈而非内窥镜治愈与临床复发,药物升级或使用皮质类固醇的风险降低相关。

 

 

原始出处:

Britt Christensen. Et al. Histologic Healing Is More Strongly Associated with Clinical Outcomes in Ileal Crohn’s Disease than Endoscopic Healing. Clinical Gastroenterology and Hepatology.2020.

 

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    2020-09-25 Tamikia

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