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Clin Gastroenterology H:粪钙卫蛋白可以预测深度缓解期炎症性肠病患者停用硫唑嘌呤后的疾病复发

2021-06-24 MedSci原创 MedSci原创

硫唑嘌呤 (AZA) 在溃疡性结肠炎 (UC) 和克罗恩病 (CD) 中的最佳治疗持续时间尚不确定,有部分患者在接受AZA治疗获得疾病缓解后就停药治疗了,本项

      硫唑嘌呤 (AZA) 在溃疡性结肠炎 (UC) 和克罗恩病 (CD) 中的最佳治疗持续时间尚不确定,有部分患者在接受AZA治疗获得疾病缓解后就停药治疗了,本项研究旨在分析持续深度缓解患者停用 AZA 后复发的临床过程和预测因素。

 

      研究人员对停止 AZA 治疗但处于无类固醇、长期深度缓解 [临床、内窥镜和组织学指标、C 反应蛋白 (CRP) 和粪便钙卫蛋白 (FC)均正常] 的患者进行了前瞻性研究。标准生化测试和 FC 在 3 个月和 6 个月时测量,然后每 6 个月测量一次。分别每 6 个月和 12 个月进行一次肠超声检查和回肠结肠镜检查评估疾病复发。使用 Cox 比例风险模型对复发预测因子进行多变量分析,并计算风险比 (HR)。还使用了 Spearman 非参数相关检验。计算了显着预测因子的准确度。

 

      57 名 IBD 患者在7年的时间里停用了AZA治疗,在中位随访时间长达50 个月后,26 名患者(18/31 UC,8/26 CD;p = 0.003)在中位 15 个月内出现疾病复发。粪钙卫蛋白(FC) 是唯一与两种疾病后期复发显着相关的变量(UC:HR 3.3,95%CI 1.2-10;CD:HR 4.5,95%CI 1.4-12.5)。FC 的敏感性、特异性、阳性和阴性预测值在 UC 中分别为 50%、100%、100%、59%,在 CD 中分别为 50%、94%、80%、81%。

 

      本项研究证实:尽管IBD患者先前已获得疾病的深度缓解,但仍有超过一半的 UC 患者和三分之一的 CD 患者在停用 AZA 后出现复发。FC 阳性与高复发风险相关。

 

 

原始出处:

Andrea Cassinotti. Et al. NON INVASIVE MONITORING AFTER AZATHIOPRINE WITHDRAWAL IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE IN DEEP REMISSION. Clinical Gastroenterology and Hepatology.2021.

 

 

 

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    2021-11-15 许安
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