初诊溃疡性结肠炎治疗后第1年内肠黏膜愈合危险因素分析
摘要
目的分析初诊溃疡性结肠炎治疗后第1年内肠黏膜愈合的危险因素。方法 123例溃疡性结肠炎患者根据治疗后第1年内肠黏膜愈合情况分为黏膜愈合组(53例)和黏膜未愈合组(70例),采用单因素分析法和多因素Logistic回归分析法分析其黏膜愈合的危险因素。结果两组在BMI、CRP、ESR> 30 mm/L、PLT> 350×109/L、病情轻度、中度、重度、临床Mayo评分、有诱导治疗应用静脉、无诱导治疗应用静脉例数上比较P均<0. 05。多因素分析显示,ESR> 30 mm/L是患者第1年内肠黏膜愈合的危险因素,高BMI是黏膜愈合的保护因素。结论ESR升高的初次诊断为溃疡性结肠炎患者难以在第1年内发生肠黏膜愈合,而高BMI患者更容易达到肠黏膜愈合。
引文
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[2]Roblin X,Boschetti G,Duru G,et al.Distinct thresholds of infliximab trough level are associated with different therapeutic outcomes in patients with inflammatory bowel disease:a prospective observational study[J].Inflamm Bowel Dis,2017,23(11):2048-2053.
[3]Pineton de Chambrun G,Peyrin-Biroulet L,Lemann M,et al.Clinical implications of mucosal healing for the management of IBD[J].Nat Rev Gastroenterol Hepatol,2010,7(1):15-29.
[4]Fr slie KF,Jahnsen J,Moum BA,et al.Mucosal heal-ing in inflammatory bowel disease:results from a Norwegian populationbased cohort[J].Gastroenterology,2007,133(2):412-422.
[5]Reinink AR,Lee TC,Higgins PD.Endoscopic mucosal healing predicts favorable clinical outcomes in inflammatory bowel disease:a meta-analy-sis[J].Inflamm Bowel Dis,2016,22(8):1859-1869.
[6]D'Haens G,Sandborn WJ,Feagan BG,et al.A review of activity indices and efficacy end points for clinical trials of medical therapy in adults with ulcerative colitis[J].Gastroenterology,2007,132(2):763-786.
[7]Truelove SC,Witts LJ.Cortisone in ulcerative colitis;fi-nal report on a therapeutic trial[J].Br Med J,1955,2(4947):1041-1048.
[8]Silverberg MS,Satsangi J,Ahmad T,et al.Toward an integrated clinical,molecular and serological classification of inflammatory bowel disease:report of a Working Party of the 2005 Montreal World Congress of Gas-troenterology[J].Can J Gastroenterol,2005,19(Suppl A):5A-36A.
[9]Travis SP,Schnell D,Krzeski P,et al.Developing an instrument to assess the endoscopic severity of ulcerative colitis:the Ulcerative Colitis Endo-scopic Index of Severity(UCEIS)[J].Gut,2012,61(4):535-542.
[10]Thia KT,Loftus EV Jr,Pardi DS,et al.Measurement of disease activity in ulcerative colitis:interobserver agreement and predictors of severity[J].Inflamm Bowel Dis,2011,17(6):1257-1264.
[11]Shi HY,Chan FK,Tsang SW,et al.Factors associated with mucosal healing in patients with ulcerative colitis in clinical remission[J].Inflamm Bowel Dis,2015,21(4):840-846.
[12]Rosenberg L,Lawlor GO,Zenlea T,et al.Predictors of endoscopic inflam-mation in patients with ulcerative colitis in clinical remission[J].Inflamm Bowel Dis,2013,19(4):779-784.
[13]Bryant RV,Winer S,Travis SP,et al.Systematic review:histological remission in inflammatory bowel disease.Is‘complete’remis-sion the new treatment paradigm An IOIBD initiative[J].JCrohns Colitis,2014,8(12):1582-1597.
[14]Marchal-Bressenot A,Salleron J,Boulagnon-Rombi C,et al.Devel-opment and validation of the Nancy histological index for UC[J].Gut,2017,66(1):43-49.
[15]Feagins LA,Melton SD,Iqbal R,et al.Clinical impli-cations of histologic abnormalities in colonic biopsy specimens from patients with ulcerative colitis in clinical remission[J].Inflamm Bowel Dis,2013,19(7):1477-1482.
[16]Lemmens B,Arijs I,Van Assche G,et al.Correlation between the endo-scopic and histologic score in assessing the activity of ulcerative colitis[J].Inflamm Bowel Dis,2013,19(6):1194-1201.
[17]Magro F,Langner C,Driessen A,et al.European consensus on the histopathology of inflammatory bowel disease[J].J Crohns Colitis,2013,7(10):827-851.
[18]Bitton A,Peppercorn MA,Antonioli DA,et al.Clinical,biological,and histologic parameters as predictors of relapse in ulcerative colitis[J].Gastroenterology,2001,120(1):13-20.
[19]Peyrin-Biroulet L,Bressenot A,Kampman W.Histologic remission:the ultimate therapeutic goal in ulcerative colitis[J].Clin Gastroenterol Hepatol,2014,12(6):929-934.
[20]Gupta RB,Harpaz N,Itzkowitz S,et al.Histologic inflammation is a risk factor for progression to colorectal neoplasia in ulcerative colitis:a cohort study[J].Gastroenterology,2007,133(4):1099-105.