PICaSSO组织学缓解指数在溃疡性结肠炎疾病评估中的价值

Evaluation value of PICaSSO histological remission index in ulcerative colitis

目的:探究PICaSSO组织学缓解指数(PHRI)在溃疡性结肠炎(UC)评估中的临床应用价值。方法:采用横断面研究方法,收集2018年6月至2019年10月北京协和医院消化内科确诊的UC患者的临床资料,包括人口学特点、蒙特利尔分型、血清学指标、Mayo总评分、Mayo内镜评分(MES)、溃疡性结肠炎内镜下严重程度指数(UCEIS)、Robarts组织病理学指数(RHI)评分和PHRI评分。采用Mayo总评分评估疾病的临床活动度。将MES=0分或UCEIS≤1分定义为内镜缓解(ER),将RHI≤3分或PHRI<1分定义为组织学缓解(HR)。采用Spearman相关性分析评估PHRI评分分别与血清学指标、内镜评分及RHI评分的相关性,采用Kappa检验分析评分间一致性。结果:共纳入60例UC患者,男性31例,女性29例;年龄(40.5±13.7)岁。其中病变位于直肠(E1)11例,左半结肠(E2)14例,广泛结肠(E3)35例。根据Mayo总评分,临床缓解20例,轻度活动20例,中度活动12例,重度活动8例。PHRI<1分15例,为PHRI-HR组;≥1分45例,为非HR组。Spearman相关性分析发现,PHRI评分与血清白蛋白水平呈负相关(r_(s)=-0.327,P=0.011);PHRI评分与MES、UCEIS评分之间呈强正相关(r_(s)=0.698、0.735,均P<0.001);PHRI评分与RHI评分呈极强正相关(r_(s)=0.868,P<0.001)。PHRI-HR组与非HR组白蛋白水平差异具有统计学意义(Z=-2.364,P=0.018)。Kappa一致性检验结果显示,MES-ER与PHRI-HR的结果中度一致(κ=0.535,P<0.001),其判断PHRI-HR的特异度为91.1%,准确度为83.3%;UCEIS-ER与PHRI-HR结果也为中度一致(κ=0.542,P<0.001),其判断PHRI-HR的特异度为90.5%,准确度为81.7%;RHI-HR与PHRI-HR的结果一致性较强(κ=0.644,P<0.001),其判断PHRI-HR的特异度为73.3%,准确度为86.7%。结论:PHRI与RHI和内镜评分密切相关,是具有潜力的评价UC疾病活动度的组织病理学评分。

Objective To explore the clinical values of PICaSSO histological remission index(PHRI)in evaluation of ulcerative colitis(UC).Methods A cross⁃sectional study was conducted.Clinical data of UC patients diagnosed in the Department of Gastroenterology of Peking Union Medical College Hospital from June 2018 to October 2019 were collected,including demography characteristics,Montreal classification,serological indicatiors,Mayo score and Mayo endoscopic score(MES),ulcerative colitis endoscopic index of severity(UCEIS),Robarts histopathology index(RHI)and PHRI.Mayo score was used to evaluate the clinical activity of the disease.MES=0 or UCEIS≤1 point was defined as endoscopic remission(ER),and RHI≤3 points or PHRI<1 point as histological remission(HR).Spearman correlation analysis was used to evaluate the correlations of PHRI with serological indicators,endoscopic scores,and RHI.Kappa test was used to analyze the consistency between scores.Results A total of 60 UC patients(31 men,29 women;mean age,40.5±13.7 years)were enrolled.The lesion located in the rectum(E1)in 11 patients,left colon(E2)in 14 and extensive colon(E3)in 35.According to the Mayo score,clinical remission occurred in 20 patients,mild activity in 20,moderate activity in 12 and severe activity in 8.A total of 15 patients with PHRI<1 point were assigned to PHRI⁃HR group,while 45 patients with PHRI≥1 point were assigned to non⁃HR group.Spearman correlation analysis showed that there was a negative correlation between PHRI and serum albumin level(r_(s)=-0.327,P=0.011);there were strong positive correlations of PHRI with MES and UCEIS scores(r_(s)=0.698,0.735,both P<0.001)and there was an extremely strong positive correlation of PHRI with RHI(r_(s)=0.868,P<0.001).The difference in serum albumin levels between the PHRI⁃HR group and the non⁃HR group was statistically significant(Z=-2.364,P=0.018).Kappa consistency test showed that the results of MES⁃ER and PHRI⁃HR were moderately consistent(κ=0.535,P<0.001),and the specificity and accuracy of PHRI⁃HR judged by MES⁃ER were 91.1%and 83.3%,respectively.The results of UCEIS⁃ER and PHRI⁃HR were also moderately consistent(κ=0.542,P<0.001),and the specificity and accuracy of PHRI⁃HR judged by UCEIS⁃ER were 90.5%and 81.7%,respectively.The results of RHI⁃HR and PHRI⁃HR were strongly consistent(κ=0.644,P<0.001),and the specificity and accuracy of PHRI⁃HR judged by RHI⁃HR were 73.3%and 86.7%,respectively.Conclusion PHRI is strongly correlated with RHI and endoscopic scores and may be a potential optimal histopathological score in evaluation of UC disease activities.