背景:评估溃疡性结肠炎(UC)粘膜愈合的非侵入性标志物的开发在治疗到目标时代是必不可少的。这项研究的目的是评估肠道超声(IUS)的性能,粪便钙卫蛋白(FC),以及它们的组合来评估UC患者的粘膜愈合。
方法:将2021年1月至2022年9月之间所有连续的UC患者纳入前瞻性队列,这些患者在4周内接受了完整的结肠镜检查和IUS和/或FC检查。评估每个节段的肠壁厚度(BWT)和彩色多普勒信号(CDS)。内窥镜粘膜愈合由0至1的Mayo评分定义。
结果:共纳入61例患者,其中79%显示内窥镜愈合(26Mayo0和11Mayo1)。在患者中,58人中有16人(27.6%)的BWT<3mm,58人中有41人(70.7%)没有CDS。敏感性,特异性,正预测值,BWT<3mm预测内镜下黏膜愈合的阴性预测值为37%,77%,72%,44%,分别。FC<150µg/g的关联,aBWT<3mm,CDS=0增加了特异性和阳性预测值(灵敏度33%,特异性94%,阳性预测值89%,阴性预测值48%)。正常IUS的组合,没有直肠出血,FC<172µg/g确定所有患者的粘膜愈合。
结论:IUS和FC的组合可有效识别UC的粘膜愈合。对于大多数UC患者,非侵入性评估粘膜愈合是可能的。
肠道超声和粪便钙卫蛋白是有效的非侵入性工具,可用于识别实现内镜粘膜愈合的溃疡性结肠炎(UC)患者。在大多数UC患者中,肠道超声和粪便钙卫蛋白的组合可有效识别UC的粘膜愈合。
BACKGROUND: The development of noninvasive markers to assess mucosal healing in ulcerative colitis (UC) is essential in the treat-to-target era. The aim of this study was to evaluate the performance of intestinal ultrasound (IUS), fecal calprotectin (FC), and their combination to assess mucosal healing in UC patients.
METHODS: All consecutive patients between January 2021 and September 2022 with UC who underwent a complete colonoscopy and IUS and/or an FC test within 4 weeks were included in a prospective cohort. Bowel wall thickness (BWT) and the color Doppler signal (CDS) were assessed for each segment. Endoscopic mucosal healing was defined by a Mayo score of 0 to 1.
RESULTS: A total of 61 patients were included, of whom 79% showed endoscopic healing (26 Mayo 0 and 11 Mayo 1). Among the patients, 16 (27.6%) of 58 had a BWT <3 mm, and 41 (70.7%) of 58 had no CDS. The sensitivity, specificity, positive predictive value, and negative predictive value of a BWT <3 mm to predict endoscopic mucosal healing were 37%, 77%, 72%, and 44%, respectively. The association of FC <150 µg/g, a BWT <3 mm, and a CDS = 0 increased the specificity and positive predictive value (sensitivity 33%, specificity 94%, positive predictive value 89%, negative predictive value 48%). The combination of a normal IUS, no rectal bleeding, and an FC <172 µg/g identified all patients with mucosal healing.
CONCLUSIONS: The combination of IUS and FC is effective in identifying mucosal healing in UC. Noninvasive evaluation of mucosal healing is possible for most UC patients.
Intestinal ultrasound and fecal calprotectin are efficient noninvasive tools to identify patients with ulcerative colitis (UC) who achieved endoscopic mucosal healing. The combination of intestinal ultrasound and fecal calprotectin is effective to identify mucosal healing in UC in most patients with UC.