BACKGROUND Due to the chronic progressive disease characteristics of primary biliary cholangitis(PBC),patients with advanced PBC should not be ignored.Most prognostic score studies have focused on early stage PBC.AIM ...BACKGROUND Due to the chronic progressive disease characteristics of primary biliary cholangitis(PBC),patients with advanced PBC should not be ignored.Most prognostic score studies have focused on early stage PBC.AIM To compare the prognostic value of various risk scores in advanced PBC to help PBC patients obtain more monitoring and assessment.METHODS This study considered patients diagnosed with PBC during hospitalization between 2015 and 2021.The clinical stage was primarily middle and late,and patients usually took ursodeoxycholic acid(UDCA)after diagnosis.The discriminatory performance of the scores was assessed with concordance statistics at baseline and after 1 year of UDCA treatment.Telephone follow-up was conducted to analyze the course and disease-associated outcomes.The follow-up deadline was December 31,2021.We compared the risk score indexes between those patients who reached a composite end point of death or liver transplantation(LT)and those who remained alive at the deadline.The combined performance of prognostic scores in estimating the risk of death or LT after 1 year of UDCA treatment was assessed using Cox regression analyses.Predictive accuracy was evaluated by comparing predicted and actual survival through Kaplan-Meier analyses.RESULTS We included 397 patients who were first diagnosed with PBC during hospitalization and received UDCA treatment;most disease stages were advanced.After an average of 6.4±1.4 years of follow-up,82 patients had died,and 4 patients had undergone LT.After receiving UDCA treatment for 1 year,the score with the best discrimination performance was the Mayo,with a concordance statistic of 0.740(95%confidence interval:0.690-0.791).The albumin-bilirubin,GLOBE,and Mayo scores tended to overestimate transplant-free survival.Comparing 7 years of calibration results showed that the Mayo score was the best model.CONCLUSION The Mayo,GLOBE,UK-PBC,and ALBI scores demonstrated comparable discriminating performance for advanced stage PBC.The Mayo score showed optimal discriminatory performance and excellent predictive accuracy.展开更多
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...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.展开更多
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 ai...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.展开更多
目的:探讨电针对肘关节僵硬松解术后患者Mayo肘关节功能评分和血清炎性因子的影响。方法:对上海健康医学院附属第六人民医院东院2018年1月至2019年10月收治的300例肘关节僵硬松解术后患者进行康复,遵循随机数字表法分为对照组与观察组,...目的:探讨电针对肘关节僵硬松解术后患者Mayo肘关节功能评分和血清炎性因子的影响。方法:对上海健康医学院附属第六人民医院东院2018年1月至2019年10月收治的300例肘关节僵硬松解术后患者进行康复,遵循随机数字表法分为对照组与观察组,各150例,对照组给予常规康复训练,观察组在常规康复训练的基础上给予电针治疗。采用酶联免疫吸附试验(ELISA)检测治疗前后炎性因子指标[白细胞介素-6(IL-6)及白细胞介素-1(IL-1)、肿瘤坏死因子-α(TNF-α)]水平的变化情况,采用Mayo肘关节功能评分,分析其临床疗效及不良反应情况。结果:观察组治疗有效率高于对照组(100.00%vs96.00%,χ^2=6.122,P=0.013);治疗前两组患者肘关节疼痛、活动范围、稳定性、活动能力及Mayo总分比较,差异无统计学意义(22.47±4.28 vs 22.53±4.31,t=0.121,P=0.904)、(8.96±2.15 vs 9.03±2.17,t=0.281,P=0.779)、(5.14±1.08 vs 5.09±1.01,t=0.414,P=0.679)、(17.69±4.25 vs 17.71±4.26,t=0.041,P=0.968)、(54.26±8.32 vs 54.36±8.37,t=0.104,P=0.917),治疗后,与对照组比较,观察组治疗后肘关节疼痛、活动范围、活动能力及Mayo总分等评分均高于对照组(39.96±7.28 vs 34.31±6.95,t=6.875,P<0.001)、(17.98±4.03 vs 13.86±3.52,t=9.430,P<0.001)、(25.63±4.52 vs 22.03±4.31,t=7.060,P<0.001)、(93.59±17.79 vs 80.05±16.69,t=6.798,P<0.001),但两组稳定性评分比较无差异(9.98±2.16 vs 9.85±2.07,t=0.532,P=0.595);治疗前,两组患者IL-6、IL-1、TNF-α水平比较差异无统计学意义[(11.82±2.41)ng/L vs(11.76±2.39)ng/L,t=0.217,P=0.829]、[(137.83±21.41)ng/L vs(139.47±19.52)ng/L,t=0.693,P=0.489]、[(47.83±11.10)ng/L vs(48.02±10.69)ng/L,t=0.151,P=0.880],治疗后,与对照组比较,观察组的IL-6、IL-1、TNF-α水平低于对照组[(9.52±1.03)ng/L vs(10.48±1.49)ng/L,t=6.491,P<0.001、[(60.31±12.48)ng/L vs(97.19±11.81)ng/L,t=27.281,P<0.001]、[(7.88±1.36)ng/L vs(23.84±4.65)ng/L,t=40.346,P<0.001];观察组与对照组不良反应发生率比较差异无统计学意义(2.00%vs 6.67%,χ^2=2.895,P=0.089)。结论:应用电针干预,能显著提高肘关节Mayo功能评分,降低术后炎性反应,对肘关节僵硬松解术后功能康复具有较好的临床效果,且具有较好的安全性,值得临床推广。展开更多
AIM 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).METHODS We review...AIM 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).METHODS We 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. Mayoendoscopic score of the rectum and sigmoid were done by two gastroenterologists. Inter-observer variability in Mayo score was assessed.RESULTS We 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). CONCLUSION Endoscopic 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.展开更多
基金Medicine Leading Talents of Yunnan Province,No.L-2019013the Yunnan Wanren Project,No.YNWR-MY-2018-028and Clinical Research Project of the Second Affiliated Hospital of Kunming Medical University,No.2020ynlc010.
文摘BACKGROUND Due to the chronic progressive disease characteristics of primary biliary cholangitis(PBC),patients with advanced PBC should not be ignored.Most prognostic score studies have focused on early stage PBC.AIM To compare the prognostic value of various risk scores in advanced PBC to help PBC patients obtain more monitoring and assessment.METHODS This study considered patients diagnosed with PBC during hospitalization between 2015 and 2021.The clinical stage was primarily middle and late,and patients usually took ursodeoxycholic acid(UDCA)after diagnosis.The discriminatory performance of the scores was assessed with concordance statistics at baseline and after 1 year of UDCA treatment.Telephone follow-up was conducted to analyze the course and disease-associated outcomes.The follow-up deadline was December 31,2021.We compared the risk score indexes between those patients who reached a composite end point of death or liver transplantation(LT)and those who remained alive at the deadline.The combined performance of prognostic scores in estimating the risk of death or LT after 1 year of UDCA treatment was assessed using Cox regression analyses.Predictive accuracy was evaluated by comparing predicted and actual survival through Kaplan-Meier analyses.RESULTS We included 397 patients who were first diagnosed with PBC during hospitalization and received UDCA treatment;most disease stages were advanced.After an average of 6.4±1.4 years of follow-up,82 patients had died,and 4 patients had undergone LT.After receiving UDCA treatment for 1 year,the score with the best discrimination performance was the Mayo,with a concordance statistic of 0.740(95%confidence interval:0.690-0.791).The albumin-bilirubin,GLOBE,and Mayo scores tended to overestimate transplant-free survival.Comparing 7 years of calibration results showed that the Mayo score was the best model.CONCLUSION The Mayo,GLOBE,UK-PBC,and ALBI scores demonstrated comparable discriminating performance for advanced stage PBC.The Mayo score showed optimal discriminatory performance and excellent predictive accuracy.
基金Clinical Medicine+X Research Project of the Affiliated Hospital of Qingdao University in 2021,No.QDFY+X202101036Qingdao Medical and Health Research Program in 2021,No.2021-WJZD166and Youth Project of Natural Science Foundation of Shandong Province,No.ZR2020QH031.
文摘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.
基金the Natural Science Foundation of Zhejiang Province(LQ21H030010&Q19H030064)Medical Health Science and Technology Project of the Zhejiang Provincial Health Commission(2021417815).
文摘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.
文摘目的:探讨电针对肘关节僵硬松解术后患者Mayo肘关节功能评分和血清炎性因子的影响。方法:对上海健康医学院附属第六人民医院东院2018年1月至2019年10月收治的300例肘关节僵硬松解术后患者进行康复,遵循随机数字表法分为对照组与观察组,各150例,对照组给予常规康复训练,观察组在常规康复训练的基础上给予电针治疗。采用酶联免疫吸附试验(ELISA)检测治疗前后炎性因子指标[白细胞介素-6(IL-6)及白细胞介素-1(IL-1)、肿瘤坏死因子-α(TNF-α)]水平的变化情况,采用Mayo肘关节功能评分,分析其临床疗效及不良反应情况。结果:观察组治疗有效率高于对照组(100.00%vs96.00%,χ^2=6.122,P=0.013);治疗前两组患者肘关节疼痛、活动范围、稳定性、活动能力及Mayo总分比较,差异无统计学意义(22.47±4.28 vs 22.53±4.31,t=0.121,P=0.904)、(8.96±2.15 vs 9.03±2.17,t=0.281,P=0.779)、(5.14±1.08 vs 5.09±1.01,t=0.414,P=0.679)、(17.69±4.25 vs 17.71±4.26,t=0.041,P=0.968)、(54.26±8.32 vs 54.36±8.37,t=0.104,P=0.917),治疗后,与对照组比较,观察组治疗后肘关节疼痛、活动范围、活动能力及Mayo总分等评分均高于对照组(39.96±7.28 vs 34.31±6.95,t=6.875,P<0.001)、(17.98±4.03 vs 13.86±3.52,t=9.430,P<0.001)、(25.63±4.52 vs 22.03±4.31,t=7.060,P<0.001)、(93.59±17.79 vs 80.05±16.69,t=6.798,P<0.001),但两组稳定性评分比较无差异(9.98±2.16 vs 9.85±2.07,t=0.532,P=0.595);治疗前,两组患者IL-6、IL-1、TNF-α水平比较差异无统计学意义[(11.82±2.41)ng/L vs(11.76±2.39)ng/L,t=0.217,P=0.829]、[(137.83±21.41)ng/L vs(139.47±19.52)ng/L,t=0.693,P=0.489]、[(47.83±11.10)ng/L vs(48.02±10.69)ng/L,t=0.151,P=0.880],治疗后,与对照组比较,观察组的IL-6、IL-1、TNF-α水平低于对照组[(9.52±1.03)ng/L vs(10.48±1.49)ng/L,t=6.491,P<0.001、[(60.31±12.48)ng/L vs(97.19±11.81)ng/L,t=27.281,P<0.001]、[(7.88±1.36)ng/L vs(23.84±4.65)ng/L,t=40.346,P<0.001];观察组与对照组不良反应发生率比较差异无统计学意义(2.00%vs 6.67%,χ^2=2.895,P=0.089)。结论:应用电针干预,能显著提高肘关节Mayo功能评分,降低术后炎性反应,对肘关节僵硬松解术后功能康复具有较好的临床效果,且具有较好的安全性,值得临床推广。
文摘AIM 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).METHODS We 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. Mayoendoscopic score of the rectum and sigmoid were done by two gastroenterologists. Inter-observer variability in Mayo score was assessed.RESULTS We 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). CONCLUSION Endoscopic 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.
