Limited validity of Mayo endoscopic subscore in ulcerative colitis with concomitant primary sclerosing cholangitis

BACKGROUND Ulcerative colitis(UC)with concomitant primary sclerosing cholangitis(PSC)represents a distinct disease entity(PSC-UC).Mayo endoscopic subscore(MES)is a standard tool for assessing disease activity in UC but its relevance in PSC-UC remains unclear.AIM To assess the accuracy of MES in UC and PSC-UC patients,we performed histological scoring using Nancy histological index(NHI).METHODS MES was assessed in 30 PSC-UC and 29 UC adult patients during endoscopy.NHI and inflammation were evaluated in biopsies from the cecum,rectum,and terminal ileum.In addition,perinuclear anti-neutrophil cytoplasmic antibodies,fecal calprotectin,body mass index,and other relevant clinical characteristics were collected.RESULTS The median MES and NHI were similar for UC patients(MES grade 2 and NHI grade 2 in the rectum)but were different for PSC-UC patients(MES grade 0 and NHI grade 2 in the cecum).There was a correlation between MES and NHI for UC patients(Spearman's r=0.40,P=0.029)but not for PSC-UC patients.Histopathological examination revealed persistent microscopic inflammation in 88%of PSC-UC patients with MES grade 0(46%of all PSC-UC patients).Moreover,MES overestimated the severity of active inflammation in an additional 11%of PSCUC patients.CONCLUSION MES insufficiently identifies microscopic inflammation in PSC-UC.This indicates that histological evaluation should become a routine procedure of the diagnostic and grading system in both PSC-UC and PSC.

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.

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.

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.

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.

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.

Comparing the clinical application values of the Degree of Ulcerative Colitis Burden of Luminal Inflammation(DUBLIN)score and Ulcerative Colitis Endoscopic Index of Severity(UCEIS)in patients with ulcerative colitis

Background:The significance of endoscopic evaluation in the diagnosis and management of ulcerative colitis(UC)has been widely recognized.Over the years,scholars have established several endoscopic scores.Herein,we assessed the clinical application value of the Mayo Endoscopic Subscore(Mayo ES),the Degree of Ulcerative Colitis Burden of Luminal Inflammation(DUBLIN)score,and the Ulcerative Colitis Endoscopic Index of Severity(UCEIS)score in UC patients,by comparing their correlation with disease activity and their predictive potential for treatment response and clinical outcomes.Methods:UC patients hospitalized from September 2015 to September 2019 were retrospectively analysed.We employed Spearman’s rank correlation coefficient to assess the linear association of the assessed endoscopic scores with the clinical parameters.The receiver-operating characteristic curve was applied to evaluate the predictive capabilities of the endoscopic scores for treatment escalation and 1-year readmission.Results:A total of 178 patients were enrolled;most of them(82%)suffered moderate or severe colitis.Among them,48(27%)patients received treatment escalation and 59(33%)were readmitted within 1 year.The DUBLIN and UCEIS scores demonstrated higher correlations with clinical parameters than the Mayo ES.The DUBLIN scores significantly differed between patients with mild,moderate,and severe colitis(all P<0.001).The UCEIS scores demonstrated the best predictabilities for treatment escalation and 1-year readmission with an area under the curve of 0.88 and 0.75,respectively.Compared to the UCEIS and DUBLIN scores,the predictive capabilities of the Mayo ES for treatment escalation(both P<0.001)and 1-year readmission(P<0.001 and P紏0.002,respectively)were lower.The UCEIS scores exhibited a significant difference between the steroid-responsive group and the steroid-dependent or steroid-refractory group(both P<0.001),while no significant differences in the Mayo ES and DUBLIN scores were found among the three groups(both P>0.05).Conclusion:This study demonstrates that both the DUBLIN and UCEIS scores outperform the Mayo ES in assessing disease severity and predicting treatment response and clinical outcomes in UC patients.

Cut-off value of ulcerative colitis endoscopic index of severity(UCEIS)score for predicting the need for pouch construction in ulcerative colitis:results of a multicenter study with long-term follow-up

Background Total proctocolectomy with ileal pouch–anal anastomosis(IPAA)was the first choice for the surgical treatment of the ulcerative colitis(UC)patients.The data on the predictive value of the ulcerative colitis endoscopic index of severity(UCEIS)for the need for IPAA in UC patients is scarce.We aimed to establish the UCEIS cut-off value to further analyse whether the UCEIS cut-off was suitable for predicting the need for IPAA in UC patients.Methods The clinical data of UC patients from June 1986 to March 2020 at our institute were retrospectively assessed.The UCEIS scores recorded at the time of the first colonoscopy after hospitalization were used in the study.Receiver operating characteristic curve analysis was performed to determine the UCEIS cut-off value for predicting the need for IPAA.Results A total of 283 UC patients were included in the study,with a median UCEIS of 4.During a median follow-up of 13 years,80 patients(28.3%)received surgery invention,among whom 75(93.8%)underwent IPAA surgery and 5(6.2%)received subtotal colectomy with permanent ostomy.A UCEIS cut-off of 6 had the most significant area under the curve of 0.769 for predicting the need for IPAA(P<0.001),with a sensitivity of 72.0%and specificity of 81.8%.UCEIS≥6 was an independent predictive factor for the need for IPAA(P<0.001)and malignant transformation(P=0.010).Patients with UCEIS≥6 had a significantly shorter IPAA-free survival time than those with UCEIS<6(P<0.001).Conclusions UCEIS≥6 may be a threshold value for decision-making for IPAA and should be recommended for UC patients for reducing the incidence of malignant transformation.

MES、UCEIS联合DUBLIN评分在溃疡性结肠炎疾病管理中的应用

目的:评价溃疡性结肠炎(UC)内镜评分系统在疾病管理中的临床应用价值。方法:回顾性分析2016年11月~2022年11月住院的203例UC患者,另随机选取206名同期健康体检者。统计两组基线特征,分析内镜评分与临床参数之间的关系。结果:UC患者的炎症指标较健康体检者升高,差异有统计学意义。评估疾病严重程度方面,Mayo内镜评分(MES)和溃疡性结肠炎内镜严重程度指数(UCEIS)更具有优势(H=187.491、156.567,P<0.001)。UCEIS和溃疡性结肠炎管腔炎症负荷严重程度评分(DUBLIN)在评估UC患者的疾病炎症负荷方面优于MES,UCEIS预测治疗反应和升级治疗方面效能较高。结论:DUBLIN评分方法简单,操作便捷,更适合在日常临床实践中应用;UCEIS可以更好地预测是否需升级治疗,适合为UC患者制定个性化的治疗方案。

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.

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.

PDW、CRP、ESR与溃疡性结肠炎UCEIS评分的相关性及联合评估预后的价值

目的探讨血小板分布宽度(PDW)、C反应蛋白(CRP)、红细胞沉降率(ESR)与溃疡性结肠炎内窥镜严重程度指数(UCEIS)评分的相关性及联合评估预后的价值。方法选取2021年3月至2022年1月商丘市第三人民医院收治的128例溃疡性结肠炎(UC)患者,采用Pearson相关性分析法分析PDW、CRP、ESR与UCEIS评分的相关性。对出院的UC患者进行1 a随访,分为预后良好组和预后不良组,比较两组临床资料,通过logistic多因素回归分析法明确影响UC患者预后的因素,绘制受试者工作特征(ROC)曲线评估PDW、CRP、ESR联合检测对UC预后的预测价值。结果Pearson相关性分析结果显示,PDW、CRP、ESR水平与UCEIS评分均呈正相关(r=0.516、0.458、0.438,P<0.05)。128例UC患者中96例预后良好,32例预后不良。预后不良组UCEIS评分、PDW、CRP、ESR、纤维蛋白原(Fib)、D-二聚体(D-D)、白细胞介素-6(IL-6)水平高,白细胞介素-10(IL-10)水平低于预后良好组(P<0.05)。logistic多因素回归分析结果显示,UCEIS评分、PDW、CRP、ESR、Fib、D-D是UC患者预后的独立危险因素,IL-10是UC患者预后的独立保护因素。ROC曲线结果显示,PDW、CRP、ESR联合检测预测UC患者预后不良的敏感度、特异度、准确度、曲线下面积分别为93.61%、71.50%、89.46%、0.892。结论PDW、CRP、ESR与UCEIS评分呈正相关,三者联合检测预测UC患者预后不良的效能较高。

溃疡性结肠炎严重程度与血清胰岛素样生长因子C反应蛋白及系统免疫炎症指数的相关性

目的探究溃疡性结肠炎(UC)严重程度与血清胰岛素样生长因子1(IGF-1)、C反应蛋白(CRP)及系统免疫炎症指数(SII)的相关性。方法回顾性分析2021年8月至2023年4月在我院接受治疗的68例UC患者的临床资料,设为观察组。选取同期健康体检者34名设为对照组。比较2组研究对象血清IGF-1、CRP及SII水平。对比不同严重程度UC患者血清IGF-1、CRP及SII水平。分析是否发生UC与三项指标间的关系。分析UC患者疾病严重程度与三项指标的相关性。结果观察组血清IGF-1水平低于对照组,血清CRP水平及SII高于对照组(P<0.05)。重度UC患者血清IGF-1水平显著低于中度患者和轻度患者,重度UC患者血清CRP水平及SII显著高于中度患者和轻度患者(P<0.05)。中度UC患者血清IGF-1水平显著低于轻度患者,血清CRP水平及SII显著高于轻度患者(P<0.05)。血清IGF-1、血清CRP、SII与患者是否发生UC均具有相关性(P<0.05)。UC患者病情严重程度与CRP、SII呈正相关,与血清IGF-1呈负相关(P<0.05)。结论血清IGF-1、CRP及SII与UC的发生发展关系密切,可作为辅助判断UC病情严重程度的指标。

血清学比值指标评估溃疡性结肠炎内镜下严重程度的临床价值

目的探讨纤维蛋白原(FIB)/清蛋白(ALB)、FIB/总胆红素(TBIL)、FIB/间接胆红素(IBIL)、C反应蛋白(CRP)/ALB、CRP/TBIL及CRP/IBIL等比值指标评估溃疡性结肠炎(UC)内镜下严重程度的临床价值。方法回顾性分析123例UC病人的临床、实验室及内镜学资料。以内镜Mayo评分作为分组标准,分为内镜缓解组(n=32)、中度活动组(n=51)及重度活动组(n=40),分析3组间各血清学指标的差异及其与内镜下疾病活动度的相关性,并绘制受试者工作特征(ROC)曲线,评估各指标预测中重度UC的诊断效能。结果内镜缓解组、中度活动组及重度活动组病人的年龄及病变部位差异有统计学意义(H=12.36,χ^(2)=56.81,P<0.01)。3组间各血清学指标差异有统计学意义(H=20.70~40.78,P<0.001),其中,重度活动组的FIB/ALB、FIB/TBIL、FIB/IBIL、CRP/ALB、CRP/TBIL、CRP/IBIL及FIB水平显著高于中度活动组和内镜缓解组,中度活动组亦高于内镜缓解组(Z=20.62~53.97,P<0.05);且上述各指标与UC内镜下活动度呈正相关关系(r=0.494~0.577,P<0.001)。而重度活动组及中度活动组的血清TBIL、IBIL均低于内镜缓解组(Z=21.17~41.28,P<0.05),且两指标与UC内镜下活动度呈负相关关系(r=-0.437~-0.417,P<0.001)。ROC曲线分析显示,CRP/TBIL、CRP/IBIL是血清学比值指标中评估UC内镜下中重度活动效能最优的指标,其曲线下面积分别为0.824和0.816。结论血清学比值指标在评价UC内镜下中重度病变方面表现良好,CRP/TBIL及CRP/IBIL是效能最优的指标。

全身免疫炎症指数评估溃疡性结肠炎严重程度的价值

目的探讨全身免疫炎症指数(SII)评估溃疡性结肠炎(UC)严重程度的临床价值。方法收集224例UC病人和224例健康对照者,比较两组的性别、年龄、体质量指数(BMI)、血红蛋白(Hb)、血小板(PLT)、中性粒细胞(NEU)、淋巴细胞(LYM)、单核细胞(MONO)、中性粒细胞与淋巴细胞比值(NLR)、血小板与淋巴细胞比值(PLR)、淋巴细胞与单核细胞比值(LMR)、SII的差异。根据改良Truelove和Witts评分(TWC)、Mayo内镜评分(MES)、溃疡性结肠炎肠道炎症负担程度(DUBLIN)、溃疡性结肠炎内镜下严重程度指数(UCEIS)评价UC活动性及严重程度,根据蒙特利尔分型评估肠道受累范围。分析SII、NLR、PLR、LMR与UC严重程度、病变范围的相关性,通过接受者操作特征曲线(ROC曲线)和多因素回归分析评估SII、NLR、PLR、LMR预测活动性UC的诊断效率。结果与对照组相比,UC组SII、NLR、PLR明显升高,LMR明显降低,差异均有统计学意义(Z=-12.47~-9.75,P<0.01)。UC组SII与TWC、MES、DUBLIN、UCEIS评分呈正相关(r=0.494~0.633,P<0.001),且不同严重程度分组间差异有统计学意义(Z=-7.12~-2.81,P<0.01),与蒙特利尔分型无相关性(r=0.007,P>0.05)。ROC曲线分析显示,SII的ROC曲线下面积(AUC=0.84)、NLR(AUC=0.78)、PLR(AUC=0.79)、LMR(AUC=0.74)对UC严重程度有预测价值(P<0.01)。多因素Logistic分析显示,SII是中重度UC的显著独立预测危险因素(OR=1.002,95%CI=1.001~1.003,P<0.05)。低体质量、正常体质量、体质量超标组间SII差异有统计学意义(Z=-9.10~-3.01,P<0.05)。结论SII是UC严重程度的独立危险因素,其升高提示机体存在营养不良,可为评估UC严重程度提供临床依据。

溃疡性结肠炎中医证型与结肠镜象结果分析研究

目的:探讨溃疡性结肠炎(ulcerative colitis,UC)中医证型与结肠镜象的相关性。方法:收集168例溃疡性结肠炎患者辨证分型资料,分析各证候与病灶范围、内镜下严重度指数评分、结肠镜黏膜主要表现的关系。结果:(1)UC中医证型分布由高至低依次为大肠湿热、肝郁脾虚、脾虚湿蕴、寒热错杂、脾肾阳虚、阴血亏虚、热毒炽盛;(2)UC中医证型分布与该病病变范围具有一定的相关性,病灶范围E1以大肠湿热和脾虚湿蕴为主,病灶范围E2以脾虚湿蕴、大肠湿热和阴血亏虚为主,病灶范围E3以脾肾阳虚和热毒炽盛为主;(3)UC不同中医证型与内镜下严重度指数的比较显示热毒炽盛证、大肠湿热证内镜下平均严重度指数显著高于其他所有证型。结论:溃疡性结肠炎黏膜血管形态、出血、糜烂溃疡及病变范围与中医证型有相关性,肠镜象表现可以为中医药防治UC提供更客观的理论依据。

结肠镜联合内镜超声对溃疡性结肠炎疾病严重程度的评估价值研究

目的 探讨结肠镜联合内镜超声检查对溃疡性结肠炎(UC)疾病严重程度的评估价值。方法 选取2018年7月至2022年4月湖州师范学院附属第一医院收治的UC患者92例。患者同时进行了结肠镜及内镜超声检查。采用改良Truelove和Witts疾病严重程度分型标准评估疾病严重程度,采用UC内镜下严重程度指数(UCEIS)进行结肠镜下疾病评分。观察患者疾病病情,分析患者UCEIS评分、内镜超声下肠壁厚度参数与疾病严重程度的相关性。比较不同疾病严重程度UC患者内镜超声下肠壁各层次间界限清晰度;logistic回归分析重度UC发生的影响因素,并构建预测模型评估其诊断效能。结果 轻度、中度、重度患者UCEIS评分分别(2.79±0.61)、(4.10±0.81)、(6.41±0.42)分,患者UCEIS评分与疾病严重程度呈正相关(rs=0.712,P<0.05)。除固有肌层厚度外,UC患者肠壁总厚度、黏膜层厚度、黏膜下层厚度与疾病严重程度均呈正相关(rs=0.672、0.723、0.626,均P<0.05)。轻度、中度、重度UC患者肠壁黏膜层与黏膜下层间界限清晰度比较差异有统计学意义(P<0.05),重度患者界限清晰度低于轻度、中度患者(均P<0.05)。logistic回归分析显示,患者病变范围、ESR、肠壁总厚度、黏膜下层厚度及黏膜下层与固有肌层间界限模糊是发生重度UC的独立影响因素(均P<0.05),建立发生重度UC的预测模型,其灵敏度为0.833,特异度为0.650,AUC为0.821(95%CI:0.713~0.928),该模型具有较好的诊断效能(P<0.05)。结论 结肠镜检查及内镜下评分可对UC严重程度进行评估,内镜超声可通过肠壁厚度和层次间清晰度变化判断UC病情严重程度。结肠镜联合内镜超声检查有助于发现重度患者并及时加以干预。

中药溃结方对难治性溃疡性结肠炎患者肠黏膜EGFR、MUC2表达的影响

目的:观察溃结方对难治性溃疡性结肠炎患者临床活动指数、内镜指数及肠黏膜EGFR、MUC2表达的影响。方法:观察溃结方治疗难治性溃疡性结肠炎有效患者21例,治疗前后记录临床症状,检查电子肠镜钳取肠黏膜,同时以10例健康体检者肠黏膜为对照组,观察临床活动指数及肠黏膜内镜指数,应用免疫组化法检测肠黏膜EGFR、MUC2表达。结果:难治性溃疡性结肠炎患者经过中药治疗后,临床活动指数与内镜指数均明显下降(P<0.01),EGFR表达水平治疗前后与正常组比较均明显上升(P<0.05,P<0.01),其中治疗后表达水平比治疗前上升更明显(P<0.05)。MUC2表达水平治疗前与正常组比较明显下降(P<0.01),治疗后表达水平上升(P<0.05)。结论:中药溃结方能明显降低难治性溃疡性结肠炎患者临床活动指数及内镜指数,增加肠黏膜组织EGFR、MUC2的表达,促进黏膜损伤的修复。

肠炎清治疗葡聚糖硫酸钠结肠炎的实验研究

【目的】验证具有清热燥湿、健脾益气、理气活血作用的中药制剂肠炎清(主要由黄连、黄芪、蒲黄、白芨、元胡等中药组成)对溃疡性结肠炎的治疗效果并探讨其疗效机制。【方法】以葡聚糖硫酸钠(DSS)饮水法复制结肠炎小鼠模型,观察该药对结肠炎小鼠疾病活动指数(DAI)和肠组织髓过氧化物酶(MRO)活性的影响。【结果】肠炎清可降低DAI和MPO活性,与柳氮磺胺吡啶(SASP)疗效相当。【结论】肠炎清对DSS结肠炎有较好的治疗效果,降低MPO的活性可能是其疗效机制之一。

中药血竭保留灌肠治疗溃疡性结肠炎

目的观察中药血竭保留灌肠治疗溃疡性结肠炎的临床疗效。方法选取我院脾胃科以溃疡性结肠炎为主要诊断的80例患者,按照随机数字表分为2组,对照组40例,采用美沙拉嗪口服治疗,实验组40例,在对照组治疗的基础上采用中药血竭保留灌肠。结束治疗后,观察2组临床症状及内镜活动指数的改善情况,对比2组患者的临床疗效。结果治疗后2组患者临床症状明显改善,实验组的临床有效率为90.00%,明显高于对照组的77.50%,差异具有统计学意义(P<0.05);治疗后实验组的腹泻、便黏液脓血、腹痛、里急后重等临床症状的评分均低于对照组,差异有统计学意义(P<0.05);治疗后实验组内镜活动指数评分明显比对照组内镜活动指数评分低,差异有统计学意义(P<0.05)。结论中药血竭具有活血止血、破瘀止痛、去腐生肌敛疮之功效,可清除氧自由基,具有抗炎止痛的作用;也可增加血流量,改善肠黏膜血液循环。应用血竭保留灌肠方法治疗溃疡性结肠炎,药物可直达病所,通过直肠直接进入血循环,使药物得到更好吸收,避免了对损害肝脏及胃肠道刺激,可明显改善临床症状,亦使药量得到充分利用。