Correlation of endoscopic disease severity with pediatric ulcerative colitis activity index score in children and young adults with ulcerative colitis

To investigate of pediatric ulcerative colitis activity index (PUCAI) in ulcerative colitis correlate with mucosal inflammation and endoscopic assessment of disease activity (Mayo endoscopic score).METHODSWe reviewed charts from ulcerative colitis patients who had undergone both colonoscopy over 3 years. Clinical assessment of disease severity within 35 d (either before or after) the colonoscopy were included. Patients were excluded if they had significant therapeutic interventions (such as the start of corticosteroids or immunosuppressive agents) between the colonoscopy and the clinical assessment. Mayo endoscopic score of the rectum and sigmoid were done by two gastroenterologists. Inter-observer variability in Mayo score was assessed.RESULTSWe identified 99 patients (53% female, 74% pancolitis) that met inclusion criteria. The indications for colonoscopy included ongoing disease activity (62%), consideration of medication change (10%), assessment of medication efficacy (14%), and cancer screening (14%). Based on PUCAI scores, 33% of patients were in remission, 39% had mild disease, 23% had moderate disease, and 4% had severe disease. There was “moderate-substantial” agreement between the two reviewers in assessing rectal Mayo scores (kappa = 0.54, 95%CI: 0.41-0.68).CONCLUSIONEndoscopic disease severity (Mayo score) assessed by reviewing photographs of pediatric colonoscopy has moderate inter-rater reliability, and agreement was less robust in assessing patients with mild disease activity. Endoscopic disease severity generally correlates with clinical disease severity as measured by PUCAI score. However, children with inflamed colons can have significant variation in their reported clinical symptoms. Thus, assessment of both clinical symptoms and endoscopic disease severity may be required in future clinical studies.

Use of the ulcerative colitis endoscopic index of severity and Mayo endoscopic score for predicting the therapeutic effect of mesalazine in patients with ulcerative colitis

Objective:The ulcerative colitis endoscopic index of severity(UCEIS)and the Mayo endoscopic score(MES)are developed as objective methods of evaluating endoscopic severity in patients with ulcerative colitis(UC).The aim of this study is to investigate the diagnostic accuracy of the UCEIS and MES in predicting the patient's response to mesalazine.Methods:Consecutive patients with UC who had undergone colonoscopy within 1 month before starting mesalazine between October 2011 and July 2016 were retrospectively collected at the Department of Gastroenterology,Sir Run Run Shaw Hospital,Zhejiang University School of Medicine.The median follow-up was 81 months,and all the data were analyzed in January 2021.The primary outcome was the need for step-up treatment,which included the use of corticosteroids,immunomodulatory,or surgery during admission and follow-up.Data were analyzed using the c2 or Fisher exact test,Spearman test,t-test,and ManneWhitney U test.Results:Totally,65 patients were enrolled,of whom 12(18.5%)needed step-up treatment due to nonresponse to mesalazine.The UCEIS score,MES,and the ulcerative colitis disease activity index(UCDAI)score were significantly higher in patients who had nonresponse to mesalazine(UCEIS score:6.92±0.69 vs.4.45±1.17,p<0.001;MES:2.67±0.49 vs.2.15±0.69,p=0.024;UCDAI score:9.33±1.87 vs.6.70±2.38,p=0.002).In the multivariate analysis,the UCEIS score(OR=25.65,95%CI:3.048 e45.985,p=0.003),UCDAI score(OR=1.605,95%CI:1.144e2.254,p=0.006),and C-reactive protein level(OR=1.056,95%CI:1.006e1.108,p=0.026)were independent risk factors of nonresponse.The area under the ROC curve of UCEIS was 0.95,with a sensitivity of 100%and specificity of 84.6%,a cut-off value of 6,which outperformed the MES with an area under the ROC curve of 0.70.When the UCEIS score≥6,60%of patients eventually needed step-up treatment.Conclusions:The UCEIS is a useful instrument for predicting the therapeutic effect in patients with UC treated with mesalazine.The high probability of mesalazine treatment failure and benefits of other therapies should be discussed in patients with baseline UCEIS score≥6.

Therapeutic and recurrence-preventing effects of Qi-Replenishing and Blood-Activating Formula in rats with acetic acid-induced gastric ulcer

Objective:To explore the therapeutic and recurrence-preventing effects of Qi-Replenishing and Blood-Activating Formula in rats with acetic acid-induced gastric ulcer.Methods:A total of 138 SD rats were selected to make rat models with gastric ulcer induced by acetic acid(24 rats with sham operation served as sham operation group),and were randomly divided into model group(n=30),western medicine group(n=30),traditional Chinese medicine(TCM) group(n=24) and combination group(combined western medicine and TCM group,n=30).Western medicine group was gavaged with omeprazole in the morning and with iso-volumetric distilled water in the afternoon;TCM group and TCM sham operation group were gavaged with iso-volumetric distilled water in the morning and with Qi-Replenishing and Blood-Activating Formula in the afternoon;combination group was gavaged with omeprazole in the morning and with Qi-Replenishing and Blood-Activating Formula in the afternoon;sham operation group and model group were gavaged with iso-volumetric distilled water both in the morning and afternoon.Ulcer indexes and degree of mucosal degree in rats at different time points after gavage were observed.Twentyeight days after gavage,interleukin(IL)-1β was given to induce ulcer recurrence so as to observe the recurrent severity and rate of ulcer in each group.Results:Compared with model group and western medicine group,treatment in combination group could prominently reduce the ulcer index of rats with peptic ulcer,and increase the healing rate and inhibition rate of peptic ulcer.After IL-1β-induced ulcer recurrence,combination group was significantly superior to model group and western medicine group in ulcer recurrent rate[50%(3/6) vs.100%(6/6)]and severity.Conclusions:Basic acid-suppression therapy combined with Qi-Replenishing and BloodActivating Formula can effectually improve the ulcer healing quality and reduce ulcer recurrence.

Protective effect of Polyalthia longifolia var.pendula leaves on ethanol and ethanol/HCl induced ulcer in rats and its antimicrobial potency

Objective:To explore antiulcer and antimicrobial properties of methanolic extract of Polyalthia longifolia var.pendula.Methods:Gastroprotective potential of Polyalthia longifolia was studied on ethanol and ethanol/HCl induced ulcers at 2 different doses(270 and 540 mg/kg/body weight). Antimicrobial efficacy of Polyalthia longifolia(25 mg/mL) was also studied against six gram positive,seven gram negative bacteria and five fungi by agar well diffusion method.Minimum inhibitory concentration was determined by agar well diffusion method in two fold serial dilution, in the range of 97-25 000μg/mL.Results:The reduction of ulcer index in Polyalthia longifolia treated animals was found to be statistically significant with respect to control animals.The Polyalthia longifolia exhibited ulcer protection activity in dose dependent manner and was also better than the standard.In antimicrobial activity,gram positive bacteria were more susceptible to Polyalthia longifolia than gram negative bacteria and fungal strains.Conclusions:Results obtained confirm the antiulcer and antimicrobial potential of the Polyalthia longifolia.

Low dose oral curcumin is not effective in induction of remission in mild to moderate ulcerative colitis: Results from a randomized double blind placebo controlled trial

AIM To evaluate the role of oral curcumin in inducing clinical remission in patients with mild to moderate ulcerative colitis(UC).METHODS A prospective randomized double-blind placebo-controlled trial comparing the remission inducing effect of oral curcumin and mesalamine 2.4 g with placebo and mesalamine 2.4 g in patients of ulcerative colitis with mild to moderate severity was conducted from January 2003 to March 2005. The included patients received 1 capsule thrice a day of placebo or curcumin(150 mg) for 8 wk. Patients were evaluated clinically and endoscopically at 0,4 and 8 wk. The primary outcome was clinical remission at 8 wk and secondary outcomes were clinical response, mucosal healing and treatment failure at 8 wk. The primary analysis was intention to treat worst case scenario(ITT-WCS).RESULTS Of 300 patients with UC, 62 patients(curcumin: 29, placebo: 33) fulfilled the inclusion criteria and were randomized at baseline. Of these, 21 patients did not complete the trial, 41 patients(curcumin: 16, placebo: 25) finally completed 8 wk. There was no significant difference in rates of clinical remission(31.3% vs 27.3%, P = 0.75), clinical response(20.7% vs 36.4%, P = 0.18), mucosal healing(34.5% vs 30.3%, P = 0.72), and treatment failure(25% vs 18.5%, P = 0.59) between curcumin and placebo at 8 wk.CONCLUSION Low dose oral curcumin at a dose of 450 mg/d was ineffective in inducing remission in mild to moderate cases of UC.

Comparison of fecal calprotectin levels and endoscopic scores for predicting relapse in patients with ulcerative colitis in remission

BACKGROUND Although the usefulness of endoscopic scores,such as the Mayo Endoscopic Subscore(MES),Ulcerative Colitis Endoscopic Index of Severity(UCEIS),and Ulcerative Colitis Colonoscopic Index of Severity(UCCIS),and biomarkers such as fecal calprotectin(FC)for predicting relapse in ulcerative colitis(UC)has been reported,few studies have included endoscopic scores for evaluating the entire colon.AIM To compare the usefulness of FC value and MES,UCEIS,and UCCIS for predicting relapse in patients with UC in clinical remission.METHODS In total,75 patients with UC in clinical and endoscopic remission who visited our institution between February 2019 and March 2022 were enrolled.The diagnosis of UC was confirmed based on the clinical presentation,endoscopic findings,and histology,according to the current established criteria for UC.Fecal samples were collected the day before or after the colonoscopy for measurement of FC.Endoscopic evaluations were performed using MES,UCEIS,and UCCIS.The primary outcome measure of this study was the assessment of the association between relapse within 12 mo and MES,UCEIS,UCCIS,and FC.The secondary outcome was the comparison between endoscopic scores and biomarkers in en-rolled patients with UC with mucosal healing.RESULTSFC and UCCIS showed a significant correlation with UCEIS (r = 0.537, P < 0.001 and r = 0.957, P < 0.001, respectively).Receiver-operating characteristic analysis for predicting MES 0 showed that the area under the curve ofUCCIS was significantly higher than that of FC (P < 0.01). During the 1-year observation period, 18 (24%) patientsexperienced a relapse, and both the FC and UCCIS of the relapse group were significantly higher than that of theremission group. The cut-off values for predicting relapse were set at FC = 323 mg/kg and UCCIS = 10.2. The areaunder the curve of the receiver-operating characteristic analysis for predicting relapse did not show a significantdifference between FC and UCCIS. The accuracy of the endoscopic scores and biomarkers in predicting relapse was86.7% for UCCIS, 85.3% for UCEIS, 76.0% for FC, and 73.3% for MES.CONCLUSIONThe three endoscopic scores and FC may predict UC relapse during clinical remission. Among these scores, UCEISmay be the most useful in terms of ease of evaluation and accuracy.

Endoscopic ultrasonography in the evaluation of condition and prognosis of ulcerative colitis

BACKGROUND Ulcerative colitis(UC)is usually diagnosed through histopathology,enteroscopy,clinical symptoms,and physical findings;however,it is difficult to accurately evaluate disease severity.AIM To investigate the value of endoscopic ultrasonography(EUS)in the evaluation of the severity and prognosis of UC.METHODS Patients with UC who were seen in our hospital from March 2019 to December 2020 were eligible,and disease severity was evaluated according to the modified Truelove and Witts and Mayo scores.We performed EUS,calculated the UC endoscopic index of severity(UCEIS)and EUS-UC scores,and administered appropriate treatment.The UCEIS and EUS-UC scores of patients were assessed in relation to disease severity,and the correlations between UCEIS and EUS-UC scores and disease severity was also analyzed.The UCEIS and EUS-UC scores before and after treatment were also compared.RESULTS A total of 79 patients were included in this study.According to the Mayo Index,23,32,and 24 patients had mild,moderate and severe UC,respectively.The UCEIS and EUS-UC scores were higher in moderate cases(4.98±1.04 and 5.01±0.99,respectively)than in mild cases(1.56±0.82 and 1.64±0.91,respectively,P<0.05).Furthermore,the UCEIS and EUS-UC scores(7.31±1.10 and 7.59±1.02,respectively)were higher in severe cases than in moderate cases(P<0.05).According to the modified Truelove and Witts scores,21,36,and 22 patients were classified as having mild,moderate and severe disease,respectively.The UCEIS and EUS-UC scores were significantly higher in moderate disease(4.79±1.11 and 4.96±1.23,respectively)than in mild disease(1.71±0.78 and 1.69±0.88,respectively,P<0.05).Additionally,the UCEIS and EUS-UC scores in severe disease(7.68±1.22 and 7.81±0.90,respectively)were significantly higher than in moderate disease(P<0.05).The UCEIS and EUSUC scores were significantly and positively correlated with disease severity according to the modified Truelove and Witts score and Mayo score(P<0.05).The UCEIS and EUS-UC scores after 2 mo of treatment(3.88±0.95 and 4.01±1.14,respectively)and after 6 mo of treatment(1.59±0.63 and 1.64±0.59,respectively)were lower than the respective scores before treatment(5.93±1.79 and 6.04±2.01)(P<0.05).CONCLUSION EUS can clarify the status of UC and accurately evaluate the treatment response,providing an objective basis for formulation and adjustment of the treatment plan.

Clinical value of the Toronto inflammatory bowel disease global endoscopic reporting score in ulcerative colitis

BACKGROUND Endoscopic evaluation in diagnosing and managing ulcerative colitis(UC)is becoming increasingly important.Several endoscopic scoring systems have been established,including the Ulcerative Colitis Endoscopic Index of Severity(UCEIS)score and Mayo Endoscopic Subscore(MES).Furthermore,the Toronto Inflammatory Bowel Disease Global Endoscopic Reporting(TIGER)score for UC has recently been proposed;however,its clinical value remains unclear.AIM To investigate the clinical value of the TIGER score in UC by comparing it with the UCEIS score and MES.METHODS This retrospective study included 166 patients with UC who underwent total colonoscopy between January 2017 and March 2023 at the Affiliated Hospital of Qingdao University(Qingdao,China).We retrospectively analysed endoscopic scores,laboratory and clinical data,treatment,and readmissions within 1 year.Spearman’s rank correlation coefficient,receiver operating characteristic curve,and univariate and multivariable logistic regression analyses were performed using IBM SPSS Statistics for Windows,version 26.0(IBM Corp.,Armonk,NY,United States)and GraphPad Prism version 9.0.0 for Windows(GraphPad Software,Boston,Massachusetts,United States).RESULTS The TIGER score significantly correlated with the UCEIS score and MES(r=0.721,0.626,both P<0.001),showed good differentiating values for clinical severity among mild,moderate,and severe UC[8(4-112.75)vs 210(109–219)vs 328(219–426),all P<0.001],and exhibited predictive value in diagnosing patients with severe UC[area under the curve(AUC)=0.897,P<0.001].Additionally,the TIGER(r=0.639,0,551,0.488,0.376,all P<0.001)and UCEIS scores(r=0.622,0,540,0.494,and 0.375,all P<0.001)showed stronger correlations with laboratory and clinical parameters,including C-reactive protein,erythrocyte sedimentation rate,length of hospitalisation,and hospitalisation costs,than MES(r=0.509,0,351,0.339,and 0.270,all P<0.001).The TIGER score showed the best predictability for patients'recent advanced treatment,including systemic corticosteroids,biologics,or immunomodulators(AUC=0.848,P<0.001)and 1-year readmission(AUC=0.700,P<0.001)compared with the UCEIS score(AUC=0.762,P<0.001;0.627,P<0.05)and MES(AUC=0.684,P<0.001;0.578,P=0.132).Furthermore,a TIGER score of≥317 was identified as an independent risk factor for advanced UC treatment(P=0.011).CONCLUSION The TIGER score may be superior to the UCIES score and MES in improving the accuracy of clinical disease severity assessment,guiding therapeutic decision-making,and predicting short-term prognosis.

Remission endpoints in ulcerative colitis: A systematic review

AIM To summarize the current consensus on the defnition of remission and the endpoints employed in clinical trials.METHODSA bibliogragraphic search was performed from 1946 to 2016 sing online databases （National Library of Medicine’s PubMed Central Medline, OVID SP MEDLINE, OVID EMBASE, the Cochrane Library and Conference Abstracts） with key words： （“ulcerative colitis”） AND （“ulcerative colitis endoscopic index of severity” OR “UCEIS”） AND （“remission”） as well as （“ulcerative colitis”） AND （“ulcerative colitis disease activity index”） OR “UCDAI” OR “UC disease activity index” OR “Sutherland index”） AND （“remission”）.RESULTSThe search returned 37 and 116 articles for the UCEIS and UCDAI respectively. For the UCEIS, 12 articles were cited in the final analysis of which 9 validation studies have been identified. Despite the UCEIS has been more extensively validated in all three aspects （validity, responsiveness and reliability）, it has been little employed to monitor disease in randomised clinical trials. For the UCDAI, 37 articles were consider-ed for the final analysis. Although the UCDAI is only partially validated, 29 randomised clinical trials were acknowledged to use the UCDAI to determine endpoints and disease remission, though no clear protocol was identifed.CONCLUSIONAlthough the UCEIS has been more widely validated than the UCDAI, it has not been refected in the moni-toring of disease activity in clinical trials. Conversely, the UCDAI has been used in numerous large clinical trials to defne their endpoints and disease remission, however, it is challenging to determine the best possible outcomes due to a lack of homogeneity of the clinical trial protocols. Before determining a gold standard index, international agreement on remission is urgently needed to advance patient care.

Progress of ulcerative colitis patients during the COVID-19 pandemic

BACKGROUND We have previously demonstrated that the first wave of the coronavirus disease 2019(COVID-19)pandemic caused exacerbations in ulcerative colitis(UC)patients,probably through psychological and physical stress.However,successive waves of the COVID-19 pandemic continuously followed the first.The effects of this chronic stress on the disease condition in UC patients are of interest.AIM To clarify the effect of chronic stress from COVID-19 on disease condition in patients aggravated after the first wave.METHODS Our previous study investigated 289 consecutive UC outpatients treated in one center during March and April 2020,the period of the first wave of the COVID-19 pandemic.In this study,an identical group of 289 UC patients was evaluated using UC-disease activity index(UC-DAI),endoscopic mucosal appearance score,and Matts pathological grade scoring.RESULTS Of the 289 UC patients included in the study in 2020,10 patients dropped out as of 2021 and another 11 patients dropped out as of 2022,making three groups for 2020,2021 and 2022.No significant differences in characteristics were found among the three groups.UC-DAI scores had aggravated during the period of the first wave of the COVID-19 pandemic,but significantly recovered in 2021 and remained stable in 2022.Matts grade scores significantly recovered in 2021 from those in 2020 and remained stable in 2022.CONCLUSION Disease activity of UC patients recovered in 2021 and remained stable in 2022,aggravated by the stress of the first wave of COVID-19 in 2020 despite persistence of the pandemic.

Evaluating mucosal healing using colon capsule endoscopy predicts outcome in patients with ulcerative colitis in clinical remission

AIM To examine whether second generation of colon capsule endoscopy(CCE-2) is acceptable for assessing the severity of mucosal inflammation and evaluating mucosal healing using CCE-2 is able to predict outcome in ulcerative colitis(UC) patients, especially in clinical remission.METHODS A total of 30 consecutive UC patients in clinical remission were enrolled to undergo CCE-2. Clinical remission was defined as clinical activity index(CAI) ≤ 4 according to Rachmilewitz index. The rate of total colon observation and colon cleansing level were evaluated. Severity of mucosal inflammation in UC was assessed according to the Mayo endoscopic subscore(MES) and Ulcerative Colitis Endoscopic Index of Severity(UCEIS). Relapsefree survival was assessed. Acceptability of CCE-2 was assessed using a questionnaire survey.RESULTS The rate of total colon observation within its battery life was 93.3%. The proportion of "excellent" plus "good" cleansing level was 73.3%. The rate of mucosal healing(MES 0, 1) assessed by CCE-2 was 77.0%. The relapse-free survival rate was significantly higher in MES 0, 1 than in MES 2, 3(P = 0.0435), and in UCEIS 0-3 than in UCEIS 4-8(P = 0.0211), whereas there was no significant difference between CAI 0 and CAI 1-4 groups. A questionnaire survey revealed an overall acceptability of CCE.CONCLUSION CCE-2 is acceptable for assessing the severity of mucosal inflammation in UC patients, especially in clinical remission. Evaluating mucosal healing using CCE-2 was able to predict outcome.

65例胃早癌脉管侵犯的相关因素分析

目的探讨胃早癌脉管侵犯的相关因素。方法回顾性分析江苏省扬州市江都人民医院2018年1月—2023年6月收治的65例胃早癌内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)患者资料。根据术后病理结果将患者分为脉管侵犯组与非侵犯组,分别为31例和34例。分析各组病例的临床特征、胃镜表现及病理特点,通过logistic回归分析探讨胃癌发生脉管浸润的独立危险因素。结果病灶>2 cm(OR=4.959,95%CI1.490~16.500)、合并溃疡(OR=3.667,95%CI 1.429~21.950)、Kit-67指数>30%(OR=9.601,95%CI2.530~36.373)、病理分化差(OR=6.440,95%CI1.822~22.760)及浸润深度T1b(tumour infiltration depth 1b,T1b)(OR=6.301,95%CI1.913~20.802)对胃早癌脉管侵犯有影响(P<0.05)。Kit-67指数>30%是脉管转移独立高危因素(P<0.05)。结论脉管侵犯与多种因素有关,Kit-67指数对评估是否合并脉管侵犯有重要临床意义。

伏诺拉生联合阿莫西林+克拉霉素治疗幽门螺杆菌感染的消化性溃疡的临床疗效评价

目的 分析幽门螺杆菌(Helicobacter Pylori, Hp)感染性消化性溃疡采取不同药物方案治疗后的效果,验证伏诺拉生联合阿莫西林+克拉霉素治疗临床优势。方法 单纯随机选取建湖县人民医院消化内科于2023年1—12月期间收治的80例Hp感染性消化性溃疡患者作为研究对象,以随机数表法分为两组,各40例。对照组采用三联疗法,观察组采用伏诺拉生联合阿莫西林+克拉霉素。比较两组治疗效果、Hp根治率、不良反应、生活质量和炎症指标。结果 治疗后,观察组治疗总有效率(95.00%)高于对照组(75.00%),差异有统计学意义(χ^(2)=5.275,P=0.012)。两组不良反应发生情况比较,差异无统计学意义(P>0.05)。观察组Hp根治率和生活质量量表各维度评分均优于对照组,差异有统计学意义(P均<0.05)。治疗后,两组患者的肿瘤坏死因子-α和白细胞介素-8水平均低于治疗前,且观察组低于对照组,差异有统计学意义(P均<0.05)。结论 伏诺拉生联合阿莫西林+克拉霉素治疗Hp消化性溃疡的临床疗效较好、安全性较高,可有效根治Hp,改善患者的炎性因子水平,提升患者的生活质量。

全身免疫炎症指数与溃疡性结肠炎疾病活动度的相关性研究

目的分析溃疡性结肠炎(UC)患者的全身免疫炎症指数(SII)水平,并评估其与疾病活动度的关系。方法纳入UC患者161例(UC组)和同期健康体检者150例(对照组)。采用改良Mayo评分评估UC组患者的疾病活动度,将其分为缓解期组26例和活动期组135例[其中轻度活动组(30例)、中度活动组(67例)和重度活动组(38例)]。收集所有受试者的一般临床特征和实验室检查指标,比较各组患者外周血SII、血小板与淋巴细胞比值(PLR)、中性粒细胞与淋巴细胞比值(NLR)等炎症指标的差异。采用Spearman相关分析评估SII与UC疾病活动度的相关性,采用受试者工作特征(ROC)曲线评估SII对UC活动期严重程度的预测价值。结果UC组患者PLR、PLT计数、NLR、中性粒细胞计数(Neu)及SII均显著高于对照组,Hb、年龄均显著低于对照组(P<0.001)。活动期组患者Neu、PLT计数、NLR、PLR、SII、C反应蛋白(CRP)及红细胞沉降率(ESR)均显著高于缓解期组,LYM显著低于缓解期组(P<0.05)。轻度活动组、中度活动组和重度活动组患者Neu、PLT计数、NLR、PLR、SII、CRP、ESR均依次升高;轻度活动组和中度活动组患者Hb水平均高于重度活动组(P<0.05)。Spearman相关分析结果显示,Neu、PLT计数、NLR、PLR、SII、CRP、ESR与UC疾病活动度及UC活动期严重程度均呈正相关,Hb与UC活动期严重程度呈负相关(P<0.001)。ROC曲线分析结果显示,ESR、PLR、PLT计数、NLR、Neu、CRP及SII对活动期UC和重度UC均具有一定预测价值(P<0.001),其中SII的AUC均最大。结论SII可能有助于评估UC疾病活动度和活动期严重程度。

老年营养风险指数、血清25羟维生素D水平与糖尿病足溃疡VSD治疗效果的关系

目的探讨老年营养风险指数(GNRI)、血清25羟维生素D[25(OH)D]水平与糖尿病足溃疡(DFU)患者负压封闭引流(VSD)治疗效果的关系。方法选取接受VSD术的DFU患者106例为DFU组,根据VSD治疗效果分为无效组(27例)和有效组(79例);同期另选取55例单纯2型糖尿病(T2DM)患者为单纯T2DM组,55名健康体检志愿者为对照组。计算GNRI,检测血清25(OH)D。用多因素Logistic回归分析DFU患者VSD治疗效果的影响因素,受试者工作特征曲线分析GNRI联合血清25(OH)D对DFU患者VSD治疗效果的评估价值。结果DFU组、单纯T2DM组、对照组GNRI、血清25(OH)D水平比较差异均有统计学意义(P均<0.05),三组GNRI、血清25(OH)D水平依次降低(P均<0.05)。Wagner分级4级、HbA1c升高为DFU患者VSD治疗无效的独立危险因素(P均<0.05),踝肱指数、GNRI、25(OH)D升高为DFU患者VSD治疗有效的独立保护因素(P均<0.05)。GNRI联合血清25(OH)D水平评估DFU患者VSD治疗效果的曲线下面积为0.879,大于二者单独评估的0.800、0.879(P均<0.05)。结论GNRI、血清25(OH)D水平低的DFU患者VSD治疗效果差,二者联合对DFU患者VSD治疗效果的评估价值较高。

下肢动脉病变程度对富血小板凝胶治疗糖尿病足溃疡的影响

目的探讨下肢动脉病变程度对富血小板凝胶治疗糖尿病足溃疡的影响。方法选取糖尿病足溃疡患者129例为研究对象。根据踝肱指数和下肢动脉血管超声结果分为轻度组49例、中度组44例和重度组36例。3组患者均给予常规治疗联合富血小板凝胶治疗。比较3组患者治疗前后溃疡面积变化和肉芽面积变化。结果3组治疗前后的溃疡面积及其差值比较,差异有统计学意义(P<0.05);3组治疗前后的肉芽面积及其差值比较,差异有统计学意义(P<0.05)。溃疡面积差值与踝肱指数呈正相关(r=0.392,P<0.001),与糖尿病病程呈负相关(r=-0.420,P<0.001);肉芽面积差值与踝肱指数呈正相关(r=0.406,P<0.001),与糖尿病病程呈负相关(r=-0.375,P<0.001)。结论下肢动脉病变越严重,富血小板凝胶治疗糖尿病足溃疡的疗效越差。

基于两样本孟德尔随机化探讨BMI增高与慢性皮肤溃疡的关系

目的基于两样本孟德尔随机化(TSMR)探讨BMI增高与慢性皮肤溃疡(CSU)的关系。方法通过全基因组关联研究数据库筛选出与BMI强相关的工具变量,在FinnGen数据库筛选CSU数据。采用TSMR分析BMI增高与CSU的关系;采用MR-Egger与逆方差加权法(IVW)检验数据异质性,MR-Egger检验数据水平多效性。结果共有334个单核苷酸多态性进行TSMR分析:其中IVW、Weighted median显示BMI增高会增加CSU的发生风险(OR=1.638、1.860,均P<0.01);而MR-Egger、Simple mode、Weighted mode等3种检验方法结果均不显著(均P>0.05)。所有数据均不存在异质性和水平多效性(均P>0.05),提示数据稳健性强且可靠。结论基于TSMR分析提示BMI增高会增加CSU的发生风险。

SIRI及SII指数在评估溃疡性结肠炎患者疾病活动度中的临床应用价值

目的探讨全身炎症反应指数(SIRI)及全身免疫炎症指数(SII)对于溃疡性结肠炎患者疾病活动程度评估中的应用价值。方法选取2020年12月至2022年12月就诊于安徽省立医院消化内科的190例溃疡性结肠炎(UC)患者为研究对象,根据Mayo评分将UC患者分为轻度活动期组、中度活动期组及重度活动期组。选取同期79例健康志愿者为健康对照组,收集所有UC患者住院期间相关检验指标和健康志愿者血常规结果,比较4组研究对象SIRI、SII、中性粒细胞与淋巴细胞比率(NLR)。结果与健康对照组相比,UC患者SIRI、SII、NLR升高,差异有统计学意义(P<0.05);重度活动期UC患者SIRI、SII、NLR水平大于中度活动期及轻度活动期患者,差异有统计学意义(P<0.05),中度活动期组UC患者SIRI、SII、NLR水平大于轻度活动期患者,差异有统计学意义(P<0.05);所有UC患者中SII、SIRI、NLR均与ESR、CRP表达水平呈正相关性(P<0.05),与清蛋白表达水平呈负相关性(P<0.05),其中SII与血红蛋白表达水平呈负相关性(P<0.05)。受试者工作特征曲线分析显示中重度活动期UC患者相对于轻度活动期,SII诊断效能大于SIRI、NLR(P<0.05),且与联合指标诊断效能相比无统计学差异(P>0.05)。结论SII、SIRI与UC患者疾病活动相关,同时对于不同疾病活动度的患者具有良好鉴别能力,且SII的预测价值优于SIRI。

甘油三酯葡萄糖乘积指数、纤维蛋白原对2型糖尿病患者并发糖尿病足溃疡的预测价值

目的探讨甘油三酯葡萄糖乘积指数(TyG)、纤维蛋白原(FIB)对2型糖尿病患者并发糖尿病足溃疡(DFU)的预测价值。方法回顾性分析358例2型糖尿病患者的临床资料,将138例未并发DFU的患者作为T2DM组,220例并发DFU的患者作为DFU组,进一步根据Wagner分级将DFU组患者分为轻度DFU组(Wagner 1~2级)106例和重度DFU组(Wagner 3~5级)114例。采用多因素Logistic回归模型分析2型糖尿病患者并发DFU的影响因素,绘制受试者工作特征(ROC)曲线评估TyG、FIB对2型糖尿病患者并发DFU的预测价值,采用Spearman相关法分析TyG、FIB与DFU组患者Wagner分级的相关性。结果多因素Logistic回归分析结果显示,TyG、FIB、2型糖尿病病程是2型糖尿病患者并发DFU的独立危险因素(P<0.05)。ROC曲线分析结果显示,TyG、FIB单独和联合预测2型糖尿病患者并发DFU的曲线下面积(AUC)分别为0.601、0.847、0.873,联合检测的AUC更大。Spearman相关分析结果显示,DFU组患者的TyG、FIB与Wagner分级均呈正相关(P<0.05)。结论TyG、FIB是2型糖尿病患者并发DFU的独立危险因素,二者可用于评估DFU病情严重程度,对2型糖尿病患者并发DFU有一定的预测价值,且联合检测的效能更高。

依帕司他胶囊联合银锌霜对糖尿病足溃疡患者创面愈合及踝肱指数的影响

目的:观察依帕司他胶囊联合银锌霜治疗糖尿病足溃疡(DFU)的疗效。方法:选择2020年6月~2023年6月某院收治的86例DFU患者作为研究对象,采用随机数字表法分为对照组和观察组,每组43例。两组均参照《中国2型糖尿病防治指南》(2013年版)予以常规治疗,对照组在常规治疗基础上予以依帕司他胶囊,观察组在对照组治疗基础上加用银锌霜。比较两组患者创面愈合情况、下肢皮温、踝肱指数、下肢疼痛程度、下肢血管功能[收缩期峰值血流速度(PSV)、内膜中层厚度(IMT)、血管弹性程度]、内皮抑素、碱性成纤维生长因子(bFGF)、血管内皮生长因子(VEGF)、炎症因子[C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、白介素-1β(IL-1β)]。结果:治疗后,两组患者下肢皮温、下肢疼痛程度、IMT、内皮抑素、CRP、TNF-α、IL-1β均低于治疗前(P<0.05),且观察组各指标水平低于对照组(P<0.05)。治疗后,两组患者踝肱指数、PSV、血管弹性程度、bFGF、VEGF均高于治疗前(P<0.05),且观察组高于对照组(P<0.05)。观察组的创面愈合时间短于对照组(P<0.05),创面愈合率高于对照组(P<0.05)。结论:依帕司他胶囊联合银锌霜可提高DFU患者的创面愈合率,缩短创面愈合时间,改善下肢皮温、踝肱指数、下肢血管功能,缓解下肢疼痛程度,可能与调节内皮抑素、bFGF、VEGF及炎症因子等的表达水平有关。