肠道超声可准确评估中重度溃疡性结肠炎患者治疗后的应答情况
创作:aluba 审核:aluba 2022年09月06日
  • 纳入27名接受8周托法替尼诱导治疗的中重度UC患者,分别通过肠道超声、内镜及组织学进行评估;
  • 肠壁厚度与内镜下Mayo评分(EMS)、UC内镜下严重程度评分(UCEIS)及Robarts组织学评分(RHI)均显著相关;
  • 在内镜缓解(EMS=0)及内镜改善(EMS≤1)患者中,乙状结肠的肠壁厚度显著降低,在内镜应答(EMS减少≥1)患者中,肠壁厚度的降低更为明显;
  • 内镜缓解、内镜改善及内镜应答所对应的肠壁厚度阈值分别为2.8mm、3.9mm及降低32%。
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aluba
肠道超声是一种非侵入性且经济划算的检测方式,可准确检测溃疡性结肠炎(UC)患者的疾病活动度。Gastroenterology上发表的一项前瞻性队列研究结果,在27名接受托法替尼治疗的中重度UC患者中,对比了肠道超声、内镜及组织学评估手段,发现基于肠道超声检测的肠壁厚度可准确地反映患者的内镜缓解、内镜改善及内镜应答。
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Gastroenterology [IF:33.883]

Intestinal ultrasound is accurate to determine endoscopic response and remission in patients with moderate to severe ulcerative colitis: a longitudinal prospective cohort study

肠道超声可准确检测中重度溃疡性结肠炎患者的内镜应答及缓解:一项纵向前瞻性队列研究

10.1053/j.gastro.2022.08.038

2022-08-24, Article

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Background and aims: Intestinal ultrasound (IUS) is non-invasive, cost-effective and accurate to determine disease activity in ulcerative colitis (UC). In this study we prospectively evaluated IUS for treatment response in a longitudinal cohort by using endoscopy and histology as gold standards.
Methods: Consecutive patients with moderate-to-severe UC (endoscopic Mayo score (EMS)≥2) starting tofacitinib treatment were included. Patients were evaluated at baseline and after 8 weeks of tofacitinib induction by means of clinical, biochemical, endoscopic (EMS and ulcerative colitis endoscopic index for severity (UCEIS)), histological (Robarts Histopathologic Index (RHI)) and IUS assessments. Readers of IUS, endoscopy and histology were blinded for all other outcomes. The primary outcome was difference in bowel wall thickness (BWT) for endoscopic improvement versus no endoscopic improvement. Endoscopic remission was defined as EMS=0, improvement as EMS≤1 and response as a decrease of EMS≥1.
Results: Thirty patients were included with 27 patients completing follow-up. BWT correlated with EMS (ρ=0.68, p<0.0001), UCEIS (ρ=0.73, p<0.0001) and RHI (ρ=0.49, p=0.002) at both time-points. BWT in the sigmoid was lower in patients with endoscopic remission (1.4mm vs 4.0mm, p=0.016), endoscopic improvement (1.8mm vs 4.5mm, p<0.0001) and decrease in BWT was more pronounced in patients with endoscopic response (-58.1% vs -13.4%, p=0.018). The most accurate cut-off values for BWT were 2.8 mm (AUC:0.87) for endoscopic remission, 3.9 mm (AUC:0.92) for improvement and decrease of 32% (AUC:0.87) for response. The submucosa was the most responsive wall layer.
Conclusion: IUS, importantly BWT as the single most important parameter, is highly accurate to detect treatment response when evaluated against endoscopic outcomes.

First Authors:
Floris de Voogd

Correspondence Authors:
Krisztina B Gecse

All Authors:
Floris de Voogd,Elsa A van Wassenaer,Aart Mookhoek,Steven Bots,Sara van Gennep,Mark Löwenberg,Geert R D'Haens,Krisztina B Gecse

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