激素治疗溃疡性结肠炎黏膜愈合程度与预后的关系

The relationship between mucosal healing and outcomes in ulcerative colitis after treatment with corticosteroids

目的探讨激素治疗溃疡性结肠炎(UC)的黏膜愈合程度与其预后的相关性。方法对接受激素治疗(n=86)的UC患者随访2年。首先在治疗6个月后对其进行早期临床疗效评价(Powel-Tuck,PT)和组织病理学分级,并将患者分为完全应答(A组:PT,0～1分;病理分级,0级)、部分应答(B组:PT,0～1分;病理分级,Ⅰ～Ⅱ级)和无应答(C组:PT≥2分;病理分级≥Ⅲ级)。随后对其疾病复发、再入院、结肠手术、免疫抑制剂使用等预后情况进行追踪,评估早期治疗UC的黏膜愈合程度和其后期预后的相关性。结果 2年后,完全(A组)和部分应答(B组)患者预后情况在以下方面出现差异:再入院率[A组27.5%vs B组44.1%;P=0.018;OR=2.24;95%CI(1.11～3.98)]、免疫抑制治疗[A组7.5%vs B组26.5%;P=0.008;OR=5.67;95%CI(3.24～8.93)]、结肠切除术[A组0.00%vs B组17.6%;P=0.035;OR=5.43;95%CI(2.14～7.64)]。结论激素治疗UC早期达到黏膜愈合与其后期良好的预后存在明显的正相关。

Objective To evaluate the relationship between mucosal healing and outcomes in ulcerative colitis （UC） after treatment with corticosteroids. Methods Patients with UC who were prescribed corticosteroid therapy （n = 86） were followed up for 2 years. They were evaluated by clinical （Powel-Tuck, PT） and histopathology grading after 6 months, outcomes at 6 months （ early response） were used to identify patients with complete （ group A ： PT, 0 - 1 ; his- topathology grading, 0） , partial （ group B ： PT, 0 - 1 ; histopathology grading, Ⅰ-Ⅱ） , or no response （group C ： PT 2 ; histopathology grading≥Ⅲ ）. The association between mucosal healing and late outcomes was assessed. Results After 2 years, there were significant differences between complete and partial responders in the rates of hospitalization [ 27.5 % in group A vs 44.1% in group B ; P = 0.018 ; OR = 2.24 ;95 % CI （ 1.11 - 3.98 ） ], immunosuppression therapy [（7.5% in group A vs26.5% in group B; P=0.008; OR=5.67;95%CI（3.24-8.93）] , coleetomy [0.00% in group A vs 17.6% in group B ; P = 0. 035 ; OR = 5.43 ;95% CI（2.14 - 7.64） ]. Conclusion Mucosal healing after corticosteroid therapy is associated with late outcomes in UC.