溃疡性结肠炎内镜缓解患者的组织学活动度评估对内镜复发的预测价值  

Value of histological activity in predicting endoscopic relapse among patients of ulcerative colitis in endoscopic remission

作　　者：刘敏 姚瑶 叶菊香 李军[2] 石雪迎 Liu Min;Yao Yao;Ye Juxiang;Li Jun;Shi Xueying(Department of Pathology,Peking University Third Hospital,Peking University School of Basic Medical Science,Beijing 100191,China;Department of Gastroenterology,Peking University Third Hospital,Beijing 100191,China)

机构地区：[1]北京大学第三医院病理科,北京大学医学部病理学系,北京100191 [2]北京大学第三医院消化科,北京100191

出　　处：《中华病理学杂志》2024年第7期709-715,共7页Chinese Journal of Pathology

摘　　要：目的探讨组织学评估对溃疡性结肠炎(ulcerative colitis,UC)内镜缓解患者的内镜复发预测价值,并对不同组织学评估标准进行比较。方法回顾性分析北京大学第三医院2015年1月1日至2021年6月30日61例UC内镜缓解患者的组织学切片,根据在该次活检后12~36个月内最近一次内镜复查结果分为内镜随访持续缓解组31例(缓解组,Mayo内镜评分0)和内镜随访复发组(复发组,Mayo内镜评分≥1)30例,采用Geboes评分(GS)及简化版GS(SGS)、Nancy指数(NI)和Robarts的组织病理学指数(RHI)进行组织学评估,取每例全部活检组织块组织学评分的中位数值和最高值;采用卡方检验进行组间单个指标比较,二元Logistic回归分析进行多因素分析,受试者工作特征(ROC)曲线分析4种组织学评价体系对内镜缓解UC患者内镜复发的预测价值。结果不同分级系统组织学评分在缓解组和复发组患者间均差异有统计学意义(P<0.05),组织学评分最高值的组间比较差异更显著;两组患者GS、SGS、NI和RHI的平均值和最高值的ROC曲线下面积(AUC值)分别为0.657、0.668、0.682、0.691和0.866、0.863、0.864、0.869,差异有统计学意义(P<0.05),对应的最佳截止值分别为GS≥2B.1,SGS≥2B.1,NI≥2和RHI≥2.5,提示组织学具有轻度活动性炎症,4种评分体系的AUC值之间差异无统计学意义(P>0.05)。单因素和多因素分析结果显示上皮和固有层内中性粒细胞数量在组间差异有统计学意义(P<0.05)。结论内镜缓解UC患者的活检组织中可能仍旧存在组织学活动性炎,并与患者内镜复发具有相关性,4种不同的常用组织学指标体系均可应用于内镜缓解UC患者内镜复发风险的评估,当内镜缓解UC患者的组织学评分大于截止值时(组织学可见轻度活动性炎)发生内镜复发的可能性增高,采用评分最高的组织块评分能更好地预测患者内镜复发的风险。各项评分指标中,上皮和固有层内可见中性�Objective To investigate the value of histological evaluation in predicting endoscopic relapse among patients with ulcerative colitis(UC)who were in endoscopic remission,and to compare the usefulness of various histological scoring systems.Methods Histological sections from 61 patients with UC who were in endoscopic remission were retrospectively analyzed,at Peking University Third Hospital,Beijing,China from January 2015 to June 2021.They were subdivided into endoscopic persistent remission group(remission group,n=31,Mayo endoscopic score 0)and endoscopic relapse group(relapse group,n=30,Mayo endoscopic score≥1)according to the results of the first endoscopic reexamination after the biopsy.Histological evaluation was performed using the Geboes score(GS)and its simplified version(SGS),the Nancy index(NI)and the Robarts histopathological index(RHI).The median and maximum histological scores for each case in all biopsies were recorded.Univariate comparisons were performed using chi-squares and multivariate analysis using binary logistic regression.The values of four histological evaluation systems for predicting endoscopic relapse among UC patients in endoscopic remission were analyzed using receiver operating characteristic(ROC)curves.Results Significant differences were observed between the remission and relapse groups.The differences were more pronounced in the maximum histological scores;the mean and highest results of area under the ROC curve scores(AUC)for GS,SGS,NI,and RHI were 0.657,0.668,0.682,0.691,and 0.866,0.863,0.864,0.869,respectively.The differences were statistically significant(P<0.05).The corresponding best cut-offs were GS≥2B.1,SGS≥2B.1,NI≥2,and RHI≥2.5,respectively,which meant mild active inflammation histologically,while there was no statistical difference of AUC among the four histological scoring indices(P>0.05).Univariate and multivariate analyses revealed statistically significant differences in the number of neutrophils in the epithelium and lamina propria(P<0.05).Conclusions Bio

关 键 词：结肠炎 溃疡性 缓解诱导 危险性评估 组织学评分体系 

分 类 号：R574.62[医药卫生—消化系统]