Clinical utility of a new endoscopic scoring system for Crohn's disease

AIM:To evaluate the clinical value of the newly modified Simple Endoscopic Score for Crohn's disease(m SES-CD).METHODS:Seventy-six Crohn's disease(CD) patients who underwent transanal double balloon endoscopy(DBE) in our hospital between 2003 and 2012 were retrospectively reviewed. DBE is defined as small intestinal endoscopy using two attached balloons. We included patients with stenosis which hampered passage of the scope and those who underwent DBE with observation for at least 80 cm from the ileocecal valve. Our new m SES-CD assesses the endoscopic activity of two consecutive small intestinal segments located 0-40 cm and 40-80 cm from the ileocecal valve by DBE,in addition to the activity of four colorectal segments. To compare the usefulness of m SES-CD with SES-CD,we similarly divided the patients into two groups according to total m SES-CD score(low disease activity group,< 4; high disease activity group,≥ 4). The clinical value of m SES-CD in predicting clinical outcome in patients with CD was evaluated using the occurrence of surgery after DBE as an endpoint.RESULTS:Median age of the 76 CD patients was 36 years(range,16-71). Thirty-nine patients had stenosis which hampered passage of the DBE to 80 cm on the proximal side from the ileocecal valve. Median evaluable length of small intestine by DBE was 80 cm(range,3-200). A total of 74 patients had one or more small intestinal lesions detected by DBE,of which 62(83.8%) were within 80 cm of the ileocecal valve on the proximal side. Only two patients(2.7%) with proximal-side lesions more than 80 cm from the ileocecal valve did not have lesions within 80 cm. Patients with high m SES-CD scores showed significantly shorter surgeryfree survival than those with low scores(P < 0.05). In contrast,surgery-free survival did not significantly differ between the low and high SES-CD groups(P > 0.05). Multivariate analysis by a Cox proportional hazards model identified m SES-CD as an independent factor for surgery-free survival.CONCLUSION:m SES-CD is useful in evaluating the risk of surgery-free survival in patients with CD.

Fecal calprotectin correlated with endoscopic remission for Asian inflammatory bowel disease patients

AIM: To evaluate the correlation between fecal calprotectin(f C), C-reactive protein(CRP), and endoscopic disease score in Asian inflammatory bowel disease(IBD) patients.METHODS: Stool samples were collected and assessed for calprotectin levels by Quantum Blue Calprotectin High Range Rapid test. Crohn's disease endoscopic index of severity(CDEIS) and ulcerative colitis endoscopic index of severity(UCEIS) were used for endoscopic lesion scoring. RESULTS: A total of 88 IBD patients [36 patients with Crohn's disease(CD) and 52 with ulcerative colitis(UC)] were enrolled. For CD patients, f C correlated with CDEIS(r = 0.465, P = 0.005) and CRP(r = 0.528, P = 0.001). f C levels in UC patients correlated with UCEIS(r = 0.696, P < 0.0001) and CRP(r = 0.529, P = 0.0005). Calprotectin could predict endoscopic remission(CDEIS < 6) with 50% sensitivity and 100% specificity(AUC: 0.74) in CD patients when using 918 μg/g as the cutoff. When using 191 μg/g as the cut-off in UC patients, calprotectin could be used for predicting endoscopic remission(UCEIS < 3) with 88% sensitivity and 75% specificity(AUC: 0.87). CONCLUSION: f C correlated with both CDEIS and UCEIS. f C could be used as a predictor of endoscopic remission for Asian IBD patients.

Faecal calprotectin and magnetic resonance imaging in detecting Crohn's disease endoscopic postoperative recurrence

AIM To assess magnetic resonance imaging(MRI) and faecal calprotectin to detect endoscopic postoperative recurrence in patients with Crohn's disease(CD).METHODS From two tertiary centers, all patients with CD who underwent ileocolonic resection were consecutively and prospectively included. All the patients underwent MRI and endoscopy within the first year after surgery or after the restoration of intestinal continuity [median = 6 mo(5.0-9.3)]. The stools were collected the day before the colonoscopy to evaluate faecal calprotectin level. Endoscopic postoperative recurrence(POR) was defined as Rutgeerts' index ≥ i2b. The MRI was analyzed independently by two radiologists blinded from clinical data.RESULTS Apparent diffusion coefficient(ADC) was lower in patients with endoscopic POR compared to those with no recurrence(2.03 ± 0.32 vs 2.27 ± 0.38 × 10^(-3) mm^2/s, P = 0.032). Clermont score(10.4 ± 5.8 vs 7.4 ± 4.5, P = 0.038) and relative contrast enhancement(RCE)(129.4% ± 62.8% vs 76.4% ± 32.6%, P = 0.007) were significantly associated with endoscopic POR contrary to the magnetic resonance index of activity(Ma RIA)(7.3 ± 4.5 vs 4.8 ± 3.7; P = 0.15) and MR scoring system(P = 0.056). ADC < 2.35 × 10^(-3) mm^2/s [sensitivity = 0.85, specificity = 0.65, positive predictive value(PPV) = 0.85, negative predictive value(NPV) = 0.65] and RCE > 100%(sensitivity = 0.75, specificity = 0.81, PPV = 0.75, NPV = 0.81) were the best cutoff values to identify endoscopic POR. Clermont score > 6.4(sensitivity = 0.61, specificity = 0.82, PPV = 0.73, NPV = 0.74), Ma RIA > 3.76(sensitivity = 0.61, specificity = 0.82, PPV = 0.73, NPV = 0.74) and a MR scoring system ≥ MR1(sensitivity = 0.54, specificity = 0.82, PPV = 0.70, and NPV = 0.70) demonstrated interesting performances to detect endoscopic POR. Faecal calprotectin values were significantly higher in patients with endoscopic POR(114 ± 54.5 μg/g vs 354.8 ± 432.5 μg/g; P = 0.0075). Faecal calprotectin > 100 μg/g demonstrated high performances to detect endoscopic POR(sensitivity = 0.67, specificity = 0.93, PPV = 0.89 and NPV = 0.77).CONCLUSION Faecal calprotectin and MRI are two reliable tools to detect endoscopic POR in patients with CD.

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.

Effective immune-inflammation index for ulcerative colitis and activity assessments

BACKGROUND The inverse association between systemic immune-inammation index(SII)and overall survival in tumors has been studied.AIM To evaluate the hematological indexes for assessing the activity of ulcerative colitis(UC).METHODS In this case-control study,172 UC patients and healthy participants were included.Comparisons were made among groups of white blood cells,hemoglobin,platelets,neutrophils,lymphocytes,monocytes,SII,neutrophil-tolymphocyte ratio(NLR),and platelet-to-lymphocyte ratio(PLR).The relationship with hematological inflammation was verified by Spearman correlation analyses.The efficiency of SII,NLR,and PLR for distinguishing between UC and severe disease status was assessed by the receiver operator curve and logistic regression analyses.RESULTS The values of SII,NLR,and PLR were higher in UC patients than in controls(P<0.001)and were positively correlated with the Mayo endoscopic score,extent,Degree of Ulcerative Colitis Burden of Luminal Inflammation(DUBLIN)score,and Ulcerative Colitis Endoscopic Index of Severity(UCEIS).The cut-off NLR value of 562.22 predicted UC with a sensitivity of 79.65%and a specificity of 76.16%.Logistic regression analysis revealed that patients with SII and NLR levels above the median had a significantly higher risk of UC(P<0.05).Risk factors independently associated with DUBLIN≥3 included SII≥1776.80[odds ratio(OR)=11.53,P=0.027]and NLR value of 2.67-4.23(OR=2.96,P=0.047)on multivariate analysis.Compared with the first quartile,SII≥1776.80 was an independent predictor of UCEIS≥5(OR=18.46,P=0.012).CONCLUSION SII has a certain value in confirming UC and identifying its activity.

不同内镜评分法评估儿童克罗恩病疾病活动度的价值

目的探讨不同内镜评分法在评估儿童克罗恩病(Crohn's disease,CD)疾病活动度中的价值。方法收集2018年1月—2023年1月于重庆医科大学附属儿童医院明确诊断的CD患儿70例,根据儿童克罗恩病活动指数(Pediatric Crohn's Disease Activity Index,PCDAI)对患儿进行临床疾病活动度评分,根据内镜下表现进行内镜镜评分。采用Spearman秩相关分析评价各内镜评分方法与PCDAI及实验室指标之间的相关性,采用Kappa检验评价结肠镜及胶囊内镜评分法与PCDAI判断CD活动度的一致性,采用受试者操作特征曲线分析实验室指标预测内镜下活动度的诊断效能。结果PCDAI得分与克罗恩病内镜下严重程度指数(Crohn's Disease Endoscopic Index of Severity,CDEIS)得分(r_(s)=0.696,P<0.01)、克罗恩病简化内镜评分(Simple Endoscopic Score for Crohn's Disease,SES-CD)得分(r_(s)=0.680,P<0.01)、Lewis评分得分(r_(s)=0.540,P<0.01)及胶囊内镜克罗恩病指数(Capsule Endoscopy-Crohn's Disease Index,CE-CD)得分(r_(s)=0.502,P<0.01)均呈中度正相关。所有内镜评分法与PCDAI在判断CD活动度中的一致性较差(Kappa=0.069~0.226)。红细胞沉降率(erythrocyte sedimentation rate,ESR)、C反应蛋白(C-reactive protein,CRP)、血细胞比容(hematocrit,HCT)、血清白蛋白(serum albumin,ALB)水平与PCDAI得分、结肠镜评分法(CDEIS、SES-CD)得分均呈中度相关(|r_(s)|=0.581~0.725,P<0.01),与各胶囊内镜评分法得分相关性弱(P<0.05)。ESR、CRP预测PCDAI、CDEIS、SES-CD、Lewis评分下CD疾病活动的曲线下面积高于HCT、ALB(P<0.05)。结论内镜评分法中CDEIS、SES-CD、Lewis评分、CE-CD可用于评估儿童CD是否存在疾病活动,但与PCDAI评估下的疾病活动度不完全一致。ESR、CRP水平升高可预测临床及内镜下儿童CD疾病活动。

平均血小板体积/淋巴细胞比值与克罗恩病患者内镜评分、疾病活动度的关系

目的 探讨平均血小板体积/淋巴细胞比值(MPVLR)与克罗恩病患者内镜评分、疾病活动度的关系。方法 回顾性选取2020年10月—2022年10月收治的126例克罗恩病作为研究对象,根据入院时简化克罗恩病活动指数将患者分入活动组(n=49)和缓解组(n=77),同时对患者进行克罗恩病国内标准内镜评分分级。另选取同期体检的100例健康志愿者作为对照组。统计所有对象临床资料及入院时MPVLR。采用多因素Logistic回归分析克罗恩病患者疾病活动度的影响因素,采用受试者工作特征曲线下面积(AUC)分析MPVLR对克罗恩病患者疾病活动度的预测价值。结果 与内镜评分轻度患者比较,重度和中度患者MPVLR水平升高,且重度患者高于中度患者(P<0.05)。与对照组比较,活动组和缓解组MPVLR水平升高,且活动组高于缓解组(P<0.05)。平均血小板体积、淋巴细胞预测克罗恩病患者疾病活动度的AUC分别为0.740、0.851,MPVLR预测的AUC为0.915。活动组肛周病变、C反应蛋白>3 mg/L比例高于缓解组,而红细胞压积与平均红细胞体积低于缓解组(P<0.01)。肛周病变、C反应蛋白、MPVLR是影响克罗恩病患者疾病活动度的独立危险因素(P<0.01)。结论 高水平MPVLR能够影响克罗恩病患者的内镜评分分级和疾病活动度,检测MPVLR可能有助于确定克罗恩病的活动期,为临床诊疗提供依据。

Urotensin II levels in patients with inflammatory bowel disease

BACKGROUND Patients with inflammatory bowel disease(IBD)are associated with increased cardiovascular risk and have increased overall cardiovascular burden.On the other hand,urotensin II(UII)is one of the most potent vascular constrictors with immunomodulatory effect that is connected with a number of different cardiometabolic disorders as well.Furthermore,patients with ulcerative colitis have shown increased expression of urotensin II receptor in comparison to healthy controls.Since the features of IBD includes chronic inflammation and endothelial dysfunction as well,it is plausible to assume that there is connection between increased cardiac risk in IBD and UII.AIM To determine serum UII levels in patients with IBD and to compare them to control subjects,as well as investigate possible associations with relevant clinical and biochemical parameters.METHODS This cross sectional study consecutively enrolled 50 adult IBD patients(26 with Crohn’s disease and 24 with ulcerative colitis)and 50 age and gender matched controls.Clinical assessment was performed by the same experienced gastroenterologist according to the latest guidelines.Ulcerative Colitis Endoscopic Index of Severity and Simple Endoscopic Score for Crohn’s Disease were used for endoscopic evaluation.Serum levels of UII were determined using the enzyme immunoassay kit for human UII,according to the manufacturer’s instructions.RESULTS IBD patients have significantly higher concentrations of UII when compared to control subjects(7.57±1.41 vs 1.98±0.69 ng/mL,P<0.001),while there were no significant differences between Crohn’s disease and ulcerative colitis patients(7.49±1.42 vs 7.65±1.41 ng/mL,P=0.689).There was a significant positive correlation between serum UII levels and high sensitivity C reactive peptide levels(r=0.491,P<0.001)and a significant negative correlation between serum UII levels and total proteins(r=-0.306,P=0.032).Additionally,there was a significant positive correlation between serum UII levels with both systolic(r=0.387,P=0.005)and diastolic(r=0.352,P=0.012)blood pressure.Moreover,serum UII levels had a significant positive correlation with Ulcerative Colitis Endoscopic Index of Severity(r=0.425,P=0.048)and Simple Endoscopic Score for Crohn’s Disease(r=0.466,P=0.028)scores.Multiple linear regression analysis showed that serum UII levels retained significant association with high sensitivity C reactive peptide(β±standard error,0.262±0.076,P<0.001)and systolic blood pressure(0.040±0.017,P=0.030).CONCLUSION It is possible that UII is involved in the complex pathophysiology of cardiovascular complications in IBD patients,and its purpose should be investigated in further studies.

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.

Role of capsule endoscopy in inflammatory bowel disease:Anything new?

Capsule endoscopy(CE)is a recently developed diagnostic method for diseases of the small bowel that is non-invasive,safe,and highly tolerable.Its role in patients with inflammatory bowel disease has been widely validated in suspected and established Crohn’s disease(CD)due to its ability to assess superficial lesions not detected by cross-sectional imaging and proximal lesions of the small bowel not evaluable by ileocolonoscopy.Because CE is a highly sensitive but less specific technique,differential diagnoses that can simulate CD must be considered,and its interpretation should be supported by other clinical and laboratory indicators.The use of validated scoring systems to characterize and estimate lesion severity(Lewis score,Capsule Endoscopy Crohn’s Disease Activity Index),as well as the standardization of the language used to define the lesions(Delphi Consensus),have reduced the interobserver variability in CE reading observed in clinical practice,allowing for the optimization of diagnoses and clinical management strategies.The appearance of the panenteric CE,the incorporation of artificial intelligence,magnetically-guided capsules,and tissue biopsies are elements that contribute to CE being a promising,unique diagnostic tool in digestive tract diseases.

补中益气汤联合英夫利西单抗治疗活动性克罗恩病临床研究

目的:观察补中益气汤联合英夫利西单抗治疗活动性克罗恩病的临床疗效,以及对患者免疫功能的影响。方法:按随机数字表法将86例活动性克罗恩病患者分为对照组和观察组,每组43例。对照组予以英夫利西单抗治疗,观察组在对照组基础上予以补中益气汤治疗。对比2组临床疗效、黏膜愈合率、复发率及不良反应发生率,观察2组治疗前后克罗恩病活动指数(CDAI)、克罗恩病内镜下严重指数(CDEIS)、免疫功能指标的变化。结果:观察组总有效率95.35%,高于对照组79.07%(P<0.05)。观察组黏膜愈合率88.37%,高于对照组69.77%(P<0.05)。观察组复发率5.56%,低于对照组35.71%(P<0.05)。治疗后,2组CDAI、CDEIS评分均较治疗前降低(P<0.05),观察组CDAI、CDEIS评分均低于对照组(P<0.05)。治疗后,2组血清CD3^(+)、CD4^(+)水平均较治疗前降低(P<0.05),血清CD4^(+)/CD25^(+)调节性T细胞(Treg)水平均较治疗前升高(P<0.05);观察组血清CD3^(+)、CD4^(+)水平均低于对照组(P<0.05),血清CD4^(+)/CD25^(+)Treg水平高于对照组(P<0.05)。观察组不良反应发生率9.30%,与对照组4.65%比较,差异无统计学意义(P>0.05)。结论:补中益气汤联合英夫利西单抗治疗活动性克罗恩病,可增强疗效、减少复发,并能改善患者的免疫功能,安全性高。

克罗恩病患者血清淀粉样蛋白A与内镜评分的相关性分析

目的 探讨血清淀粉样蛋白A(serum amyloid A, SAA)与克罗恩病(Crohn’s disease, CD)患者内镜评分的相关性。方法 选取同济大学附属第十人民医院2021年1月—2022年2月收治的103例CD患者,检测所有患者SAA、C反应蛋白(C-reactive protein, CRP)、红细胞沉降率(erythrocyte sedimentation rate, ESR)、白介素-6(interleukin-6, IL-6)、肿瘤坏死因子-α(tumor necrosis factor-α, TNF-α)及白介素-1β(interleukin-1β, IL-1β)浓度,所有患者均进行结肠镜检查并行CD简化内镜评分(simple endoscopic score in CD, SES-CD),探讨各炎症指标与SES-CD的相关性。结果 SAA、CRP、ESR、IL-6、TNF-α浓度与SES-CD评分均呈正相关,相关系数(rs)分别为0.585、0.552、0.400、0.297、0.208,均P<0.05,IL-1β浓度与SES-CD无相关性;SAA、CRP、ESR预测SES-CD的曲线下面积值(AUC)分别为0.809、0.766、0.721,均P<0.001。结论 与其他炎症指标相比,SAA能够更好地预测CD患者黏膜愈合情况,尤其适用于经济能力有限或内镜检查依从性差的反复复发的CD患者疾病活动性的评估,值得临床推广应用。

炎症性肠病患者血清胆红素水平分析

目的 分析炎症性肠病(IBD)患者血清胆红素(sTB)水平,探讨其与患者病情的关系。方法 选取2019年1月-2020年9月在南京市中医院就医并确诊的IBD患者165例,其中克罗恩病患者80例(CD组)、溃疡性结肠炎患者85例(UC组),收集同期体检健康者163例作为健康人对照组。检测IBD患者sTB、红细胞沉降率(ESR)、C反应蛋白(CRP)和血红蛋白(Hb)水平,分析IBD患者血清sTB水平的变化,及其在患者不同病变范围中的水平差异,探讨sTB与IBD患者疾病活动性的严重程度(UC患者改良Mayo评分、CD患者简化CDAI评分)、ESR、CRP和Hb的相关性。结果 与对照组血清sTB[(12.99±2.71)μmol/L]相比,CD组[(9.48±3.29)μmol/L]和UC组[(10.14±5.11)μmol/L]患者血清sTB的水平均显著降低(P<0.001),CD组和UC组患者血清sTB的水平比较差异无统计学意义(P>0.05)。UC患者中,不同病变范围患者,即直肠病变组(E1)[9.90 (7.30,13.70)μmol/L]、左半结肠病变组(E2)[10.70 (6.70,15.90)μmol/L]和广泛结肠组(E3)[6.80 (5.10,11.70)μmol/L]血清sTB水平差异有统计学意义(H=7.793,P=0.020)。相关性分析结果显示,UC患者sTB与改良Mayo评分(r=-0.359,P=0.001)、CRP(r=-0.496,P<0.001)和ESR(r=-0.483,P<0.001)水平呈负相关,与Hb水平呈正相关(r=0.534,P<0.001)。CD患者sTB与简化CDAI评分呈负相关(r=-0.578,P<0.001),与Hb水平呈正相关(r=0.375,P<0.001),与CRP和ESR水平无相关性(P>0.05)。结论 IBD患者的sTB水平降低,分析IBD患者sTB的水平有助于评估患者疾病活动程度,可为判断UC病变范围提供新的参考指标。

克罗恩病简化内镜评分(SES-CD)与临床和实验室指标相关性的研究

背景:内镜活动性已被作为克罗恩病(CD)治疗的评估终点。CD简化内镜评分(SES-CD)是一种简单、易用的内镜评分方法,目前关于SES-CD与非侵入性炎症相关指标关系的研究尚少。目的:探讨SES-CD与临床和实验室炎症相关指标的相关性,确定适宜的判断CD内镜活动性的非侵入性指标。方法:纳入42例CD患者,行实验室炎症相关指标[白细胞(WBC)计数、血小板(PLT)计数、C-反应蛋白(CRP)、红细胞沉降率(ESR)、血红蛋白(Hb)、白蛋白(Alb)、粪便钙卫蛋白(FC)]检测和SES-CD、CD活动指数(CDAI)评估。以ROC曲线分析各项指标对CD内镜下活动的预测效能,分析SES-CD与各项指标的相关性。结果:活动期CD的PLT计数、CRP、ESR、FC、SES-CD显著高于缓解期CD,Hb和Alb显著低于缓解期CD(P均<0.05)。各项非侵入性指标中,仅CDAI和FC预测CD内镜下活动的ROC曲线下面积(AUC)在0.9以上;CDAI以≥150为界值、FC以正常上限(ULN,≥50μg/g)为界值,相应敏感性分别为58.8%和100%,特异性分别为100%和60.0%。SES-CD与CDAI、PLT计数、CRP、ESR、Alb、FC之间存在中度相关性(P均<0.05)。结论:SES-CD与临床和实验室炎症相关指标具有较好的相关性,但传统炎症相关指标CDAI、CRP、ESR以ULN为界值无法敏感、准确地反映CD内镜下活动,FC则有较高的准确性和敏感性,可作为非侵入性指标用于CD内镜活动性的评估。

克罗恩病内镜评分标准与疾病活动度相关性研究

目的评价国内外两种不同的克罗恩病(CD)内镜评分标准与CD临床疾病活动度以及两种评分标准间的一致性。方法选择2007年7月至2011年8月在本院行内镜检查(全结肠镜或双气囊小肠镜)的CD患者共70例,按国内标准(CGSCD)与简化CD内镜评分(SESCD)两种评分标准由2位医师独立评价,并收集同期临床资料与实验室指标,数据处理使用SPSS13.0。结果 SESCD与CGSCD两种评分标准之间具有显著的相关性,Spearman相关系数为0.776(P<0.01)。这两种内镜评分标准与血沉(ESR)、C反应蛋白、红细胞压积、血红蛋白、简化CDAI之间均有统计学意义的相关性(P<0.05),但简化CD内镜评分标准与疾病临床活动度的相关性更大。两种内镜评分标准在治疗前后的变化值与ESR、CRP、HCT、HB、简化CDAI的变化值间均无统计学意义上的相关性(P>0.05)。结论 CD的两种内镜分级和评分标准具有显著的一致性,且与疾病临床活动度以及评价活动度的实验室指标均具有较良好的相关性,但与治疗前后疾病活动度变化并不一致。国内CD内镜分级标准尚待改进。

CESI、简化CDAI和CRP在评估小肠克罗恩病病变范围和活动程度中的应用价值

背景:小肠克罗恩病(CD)是一种慢性、反复发作性疾病。目前胶囊内镜评分指数(CESI)、简化CDAI和CRP在评估小肠CD病变范围和活动程度中的应用价值的研究甚少。目的:探讨CESI、简化CDAI和CRP在评估小肠CD病变范围和活动程度中的应用价值。方法:纳入行胶囊内镜检查并最终确诊为小肠CD的患者58例。分析简化CDAI和CRP与小肠病变范围的关系;评估小肠CD患者临床特征与CESI的相关性;计算简化CDAI和CRP判断胶囊内镜下炎症活动期的敏感性、特异性、阳性预测值、阴性预测值和准确性。对治疗后11例小肠CD患者行胶囊内镜复查,分析CESI改变与简化CDAI和CRP改变的相关性。结果:不同小肠病变范围的简化CDAI和CRP相比差异无统计学意义(P>0.05);小肠CD患者临床特征与CESI无关;简化CDAI和CRP判断胶囊内镜下炎症活动期的敏感性、特异性、阳性预测值、阴性预测值和准确性均较低。治疗后,CESI改变与简化CDAI和CRP改变无相关性(P>0.05)。结论:简化CDAI和CRP并不能反映胶囊内镜下小肠CD患者病变范围和活动程度;小肠CD的胶囊内镜下黏膜修复情况与临床症状和生化指标的改善不一致,胶囊内镜下病变好转迟滞于简化CDAI和CRP的改善。

清热化湿中药保留灌肠治疗溃疡性结肠炎疗效观察

目的观察中药保留灌肠对溃疡性结肠炎(ulcerative colitis,UC)的疗效。方法将60例轻中度UC患者随机分为观察组和对照组,每组30例。对照组采用美沙拉秦栓塞肛,观察组采用中药保留灌肠,治疗时间为8周。评价两组临床疗效,比较两组治疗前、治疗4周末、治疗8周末的疾病活动指数(disease activity index,DAI)、Baron内镜评分和Geboes指数,采用中文版炎症性肠病生存质量问卷(inflammatory bowel disease quality questionnaire,IBDQ)评价两组患者治疗前后的生存质量,观察两组恶心、腹胀、腹痛、便次增多等不良反应的发生。结果观察组临床总有效率(93.3%)高于对照组(73.3%),但两组临床疗效分布比较,差异无统计学意义(Z=-1.902,P=0.057)。治疗4周末、8周末两组DAI评分均显著降低(P< 0.05 ),且观察组显著低于对照组(P<0.05)。广义估计方程分析结果显示,对照组与观察组比较,Baron内镜评分和Geboes指数的优势比(odds ratio,OR)分别为2.12、2.30;治疗8周末与治疗4周末、治疗前比较,Baron内镜评分的OR值分别为63.66、6.50,Geboes指数的OR值分别为33.57、9.45。两组治疗后生存质量评分与治疗前相比,肠道症状、情感能力、社会能力、全身症状4个维度上得分均显著提高,且观察组4个维度评分升高值均显著大于对照组(P<0.05)。治疗期间,对照组共15例患者出现恶心、腹痛、腹胀、大便次数增多,观察组共5例患者出现恶心、腹痛、大便次数增多,观察组不良反应发生率显著低于对照组(P<0.05)。结论中药保留灌肠能有效治疗UC,降低疾病活动指数,改善内镜评分,提高生存质量。

参苓白术散合附子理中丸联合西药治疗克罗恩病临床研究

目的:观察参苓白术散合附子理中丸加减联合西药治疗脾胃虚寒型克罗恩病(CD)的临床疗效。方法:将80例患者随机分为对照组和观察组各40例。2组中的轻度患者均服用美沙拉嗪肠溶片,中度患者加服泼尼松龙片,观察组同时予参苓白术散合附子理中丸加减治疗。2组均连续治疗12周。治疗前后和随访期(3个月)评定克罗恩病严重程度(CDAI)评分、中医症状评分和炎症性肠病生活质量问卷(IBDQ)评分,检测红细胞沉降率(ESR)和C-反应蛋白(CRP)水平,比较2组的临床疗效。结果:观察组临床缓解率为90.0%,高于对照组的70.0%(P<0.05);观察组有效率为97.5%,高于对照组的80.0%(P<0.05)。在3个月的随访期间,观察组复发率为12.5%,低于对照组的35.0%(P<0.05)。2组CDAI评分和中医症状积分均较治疗前下降(P<0.01),观察组2项分值均低于对照组(P<0.01)。2组IBDQ肠道症状、全身症状、情感功能、社会功能评分和IBDQ总分均较治疗前升高(P<0.01),观察组各个维度评分和IBDQ总分均高于对照组(P<0.01)。结论:参苓白术散合附子理中丸联合西药治疗脾胃虚寒型CD患者,能有效缓解临床症状,减轻炎症反应,促使病程进入缓解期,提高了治疗效果,改善了患者的生活质量,降低了疾病的近期复发率。

克罗恩病组织中网状蛋白-1C的表达水平及意义

目的探究克罗恩病(CD)组织中网状蛋白-1C(RTN-1C)的表达水平及意义。方法选择2016年3月至2018年1月确诊并接受治疗的113例CD患者作为研究对象。用蛋白质免疫印迹法检测CD组织中RTN-1C的表达水平,并分析其与内镜下疾病活动度及预后的关系。结果随着CD组织中RTN-1C表达水平的升高,其内镜下疾病活动度降低。CD患者的RTN-1C水平与CD简化内镜评分(SES-CD)呈负相关关系(P<0.05)。113例CD患者中有34例(30.09%)患者的预后不良。预后不良患者的RTN-1C水平低于预后良好患者,差异有统计学意义(P<0.05)。RTN-1C诊断CD患者预后的受试者工作特征曲线(ROC)下面积(AUC)、最佳截断点、敏感度和特异度分别为0.809、1.91、91.18%和58.23%。单因素及Logistic多因素分析结果显示,疾病行为、肛周病变是CD患者预后的独立危险因素(P<0.05),RTN-1C是CD患者预后的独立保护因素(P<0.05)。结论CD组织中RTN-1C表达水平越低提示病情越严重。检测CD患者的RTN-1C表达水平有利于判断预后。

炎症性肠病患者血浆TRAF1的表达及其临床意义

目的比较炎症性肠病患者血浆肿瘤坏死因子受体相关因子-1(tumor necrosis factor receptor-assoc iated factor-1,TRAF-1)水平和正常对照者的差异,分析血浆TRAF1水平对炎症性肠病的诊断价值以及与内镜下疾病活动性的相关性。方法共纳入62例克罗恩病患者、64例溃疡性结肠炎患者和56例正常对照者。应用酶联免疫吸附试验(Enzym e-linked immuno-sorbent assay,ELISA)分析炎症性肠病患者和正常对照者血浆中TRAF1蛋白的表达,受试者工作特征曲线(rece iver-operating characteristic,ROC)分析血浆TRAF1水平对克罗恩病和溃疡性结肠炎的诊断价值,应用Pearson相关分析研究血浆TRAF1水平与内镜下疾病活动性的相关性。结果克罗恩病患者(P=0.000)和溃疡性结肠炎患者(P=0.000)血浆TRAF1水平显著高于正常对照者,同时TRAF1对区分克罗恩病患者和正常对照者(P=0.000)以及区分溃疡性结肠炎患者和正常对照者(P=0.000)具有显著的诊断价值。克罗恩病患者血浆TRAF1表达水平和内镜下疾病活动指数呈较低的负相关(r=-0.260,P=0.041),而溃疡性结肠炎患者血浆TRAF1水平与内镜下疾病活动程度无显著相关性(r=0.029,P=0.821)。结论炎症性肠病患者血浆TRAF1水平增高,血浆TRAF1水平对区分炎症性肠病患者和正常对照者具有诊断价值,但血浆中TRAF1的水平不能反应内镜下疾病活动程度。