溃疡性结肠炎内镜评分与临床活动度及组织学评分的相关性研究
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1.南京大学医学院附属鼓楼医院消化内科;2.南京大学医学院附属鼓楼医院病理科

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南京市医学重点科技发展项目(ZKX15018)


Correlation between endoscopic scores and clinical activity and histological scores of ulcerative colitis
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Department of Digestive Medicine,Nanjing Drum Tower Hospital the Affiliated Hospital of Nanjing University Medical School

Fund Project:

Key Medical Science and Technology Development Project of Nanjing (ZKX15018)

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    摘要:

    目的 本研究通过现有的溃疡性结肠炎(ulcerative colitis, UC)内镜评分评估UC患者肠道黏膜状态,并探讨UC内镜评分与临床疾病活动度及组织学活性的相关性。 方法 回顾性分析2014年1月—2019年9月于南京鼓楼医院消化内科住院并行乙状结肠镜或结肠镜检查的152例患者的内镜检查结果,使用梅奥内镜子评分(Mayo endoscopic score,MES)、改良Baron评分(modified Baron score,MBS)、内镜活动指数(endoscopic activity index,EAI)、Sutherland指数(Sutherland index,DAI)、Rachmilewitz内镜指数(Rachmilewitz endoscopic index,REI)、Lemann内镜指数(Lemann endoscopic index,LEI)、溃疡性结肠炎内镜严重度指数(ulcerative colitis endoscopic index of severity,UCEIS)这7种UC内镜评分进行评分,并计算各内镜评分与部分Mayo评分和Truelove-Witts疾病严重分级2种临床活动度评分及Nancy指数、Robarts组织病理学指数、Geboes评分这3种组织学评分的Spearman等级相关系数。分析并比较各内镜评分在观察者间的一致性。 结果 除DAI与Truelove-Witts分级相关性较弱(r=0.469,P<0.001)外,其余内镜评分与临床活动度评分均呈显著的中度正相关(P<0.001),但各内镜评分与3种组织学评分的相关性均较弱(P<0.001)。除MBS在观察者间一致性中等外,MES、DAI、LEI观察者间一致性较差,UCEIS、EAI、REI观察者间一致性更差(P<0.001)。 结论 各内镜评分与UC的临床评分呈显著的中等正相关,与组织学评分之间具有统计学意义的弱相关,但内镜下达缓解的患者其黏膜组织学炎症可能持续存在,故在黏膜愈合的基础上尚需关注组织学愈合。7种内镜评分在观察者间的一致性均较低,重复性欠佳。

    Abstract:

    Objective To study the intestinal mucosal state of ulcerative colitis (UC) through UC endoscopic scores and to investigate the correlation between the endoscopic scores and clinical activity and histological scores. Methods A retrospective analysis was performed on data of 152 patients who underwent colonoscopy or sigmoidoscopy in Nanjing Drum Tower Hospital from January 2014 to September 2019. The results were graded with 7 endoscopic scores, namely, Mayo endoscopic score(MES), modified Baron score(MBS), endoscopic activity index(EAI) , Sutherland index(DAI or UCDAI) , Rachmilewitz endoscopic index(REI), Lemann endoscopic index (LEI), and ulcerative colitis endoscopic index of severity(UCEIS). Spearman correlation coefficients between endoscopic score and partial Mayo scores, Truelove-Witts disease severity score and Nancy index (NI), Robarts index (RHI) and Geboes score (GS) were calculated respectively. Consistency of each endoscopic score among different observers was analyzed. Results Except for the weak correlation between DAI and Truelove - Witts classification (r= 0.469, P < 0.001), all other endoscopic scores were moderately positively correlated with clinical activity scores with significance( all P<0.001). However,the correlation between 7 endoscopic scores and histological scores was weak (P<0.001). Except that the consistency of MBS among observers was medium, those of MES, DAI and LEI among observers were poor, and those of UCEIS, EAI and REI among observers were worse (P<0.001). Conclusion Endoscopic scores were moderately correlated with clinical activity indexes and weakly correlated with histological scores. However, patients with endoscopic remission may have histologic inflammatory activity, so attention should be paid to histological mucosal healing after endoscopic remission. The consistency of all 7 endoscopic scoring stystems among observers was low, and the repeatability was poor.

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陈霞飞,孙琦,张晓琦,等.溃疡性结肠炎内镜评分与临床活动度及组织学评分的相关性研究[J].中华消化内镜杂志,2021,38(6):447-453.

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历史
  • 收稿日期:2020-04-13
  • 最后修改日期:2021-03-29
  • 录用日期:2020-06-08
  • 在线发布日期: 2021-07-06
  • 出版日期: 2021-07-01
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