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Complete Resolution of Mucosal Neutrophils Associates With Improved Long-Term Clinical Outcomes of Patients With Ulcerative Colitis.
Clinical Gastroenterology and Hepatology ( IF 12.6 ) Pub Date : 2019-12-14 , DOI: 10.1016/j.cgh.2019.12.011
Rish K Pai 1 , Douglas J Hartman 2 , Claudia Ramos Rivers 3 , Miguel Regueiro 4 , Marc Schwartz 3 , David G Binion 3 , Reetesh K Pai 2
Affiliation  

Background & Aims

We investigated correlations between histologic features of the colonic mucosa in patients with ulcerative colitis (UC) and clinical outcomes during a 3-year follow-up period.

Methods

We obtained baseline biopsies from all colorectal segments (n = 889) from 281 patients with UC enrolled in a prospective study at a single center from 2009 through 2013. Biopsies were assessed in a blinded manner using validated histologic scoring systems (the Geboes score, Nancy histopathologic index, and Robarts histopathologic index). Clinical, endoscopic, and histologic data were collected and tested for correlations with systemic corticosteroid use, hospitalization, and colectomy within 3 years of the index colonoscopy.

Results

We found histologic evidence of UC activity (Geboes score ≥ 2B.1) in biopsies from 182 patients (65%) and endoscopic evidence of UC activity in 149 patients (53%) (substantial agreement, κ = 0.60). Histologic features of UC activity were associated with increased rates of systemic corticosteroid use, colectomy, and hospitalization in the entire cohort (P < .05 for all) and associated with increased rates of systemic corticosteroid use in an analysis limited to patients in endoscopic remission (P < .001). In patients in endoscopic remission, only histologic activity was independently associated with use of systemic corticosteroids (multivariate odds ratio, 6.34; 95% CI, 2.20–18.28; P = .001). Similar results were seen when the entire cohort was analyzed. Compared with patients without histologic evidence of UC activity, patients with only a small number of mucosal neutrophils still had higher rates of systemic corticosteroid use (P < .001).

Conclusions

Histologic evidence of UC activity, including small numbers of neutrophils in the colonic mucosa, is the only factor independently associated with use of systemic corticosteroids. Complete resolution of neutrophil-associated inflammation should be a target for treatment of UC.



中文翻译:

粘膜中性粒细胞的完全消退与溃疡性结肠炎患者长期临床结果的改善相关。

背景与目标

我们调查了溃疡性结肠炎 (UC) 患者结肠黏膜组织学特征与 3 年随访期间临床结果之间的相关性。

方法

我们从 2009 年至 2013 年在单一中心参与一项前瞻性研究的 281 名 UC 患者的所有结直肠段(n = 889)获得基线活检。使用经过验证的组织学评分系统(Geboes 评分,Nancy组织病理学指数和 Robarts 组织病理学指数)。收集临床、内窥镜和组织学数据,并测试其与结肠镜检查后 3 年内全身性皮质类固醇使用、住院和结肠切除术的相关性。

结果

我们在 182 名患者 (65%) 的活组织检查中发现了 UC 活动的组织学证据(Geboes 评分 ≥ 2B.1),并在 149 名患者 (53%) 中发现了 UC 活动的内镜证据(基本一致,κ = 0.60)。UC 活动的组织学特征与整个队列中全身性皮质类固醇使用率、结肠切除术和住院率的增加有关(所有P < .05),并且在仅限于内镜缓解患者的分析中与全身性皮质类固醇使用率的增加相关。P < .001)。在内镜下缓解的患者中,只有组织学活动与全身性皮质类固醇的使用独立相关(多变量比值比,6.34;95% CI,2.20-18.28;P= .001)。当分析整个队列时,也看到了类似的结果。与没有组织学证据表明存在 UC 活动的患者相比,仅有少量黏膜中性粒细胞的患者全身皮质类固醇使用率仍然较高 ( P < .001)。

结论

UC 活动的组织学证据,包括结肠黏膜中的少量中性粒细胞,是与全身性皮质类固醇使用独立相关的唯一因素。中性粒细胞相关炎症的完全消退应该是 UC 治疗的目标。

更新日期:2019-12-14
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