首页|Development and validation of a novel criterion of histologic healing in ulcerative colitis defined by inflammatory cell enumeration in lamina propria mucosa:A multicenter retrospective cohort in China

Development and validation of a novel criterion of histologic healing in ulcerative colitis defined by inflammatory cell enumeration in lamina propria mucosa:A multicenter retrospective cohort in China

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  • 国家科技期刊平台
  • NETL
  • NSTL
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Background:Histological healing is closely associated with improved long-term clinical outcomes and lowered relapses in patients with ulcerative colitis(UC).Here,we developed a novel diagnostic criterion for assessing histological healing in UC patients.Methods:We conducted a retrospective cohort study in UC patients,whose treatment was iteratively optimized to achieve mucosal healing at Shanghai Tenth People's Hospital of Tongji University from January 2017 to May 2022.We identified an inflammatory cell enumeration index(ICEI)for assessing histological healing based on the proportions of eosinophils,CD177+neutrophils,and CD40L+T cells in the colonic lamina propria under high power field(HPF),and the outcomes(risks of symptomatic relapses)of achieving histological remission vs.persistent histological inflammation using Kaplan-Meier curves.Intrareader reliability and inter-reader reliability were evaluated by each reader.The relationships to the changes in the Nancy index and the Geboes score were also assessed for responsiveness.The ICEI was further validated in a new cohort of UC patients from other nine university hospitals.Results:We developed an ICEI for clinical diagnosis of histological healing,i.e.,Y=1.701X1+0.758X2+1.347X3-7.745(X1,X2,and X3 represent the proportions of CD177+neutrophils,eosinophils,and CD40L+T cells,respectively,in the colonic lamina propria under HPF).The receiver operating characteristics curve(ROC)analysis revealed that Y＜-0.391 was the cutoff value for the diagnosis of histological healing and that an area under the curve(AUC)was 0.942(95％confidence interval[CI]:0.905-0.979)with a sensitivity of 92.5％and a specificity of 83.6％(P＜0.001).The intraclass correlation coefficient(ICC)for the intrareader reliability was 0.855(95％CI:0.781-0.909),and ICEI had good inter-reader reliability of 0.832(95％CI:0.748-0.894).During an 18-month follow-up,patients with histological healing had a substantially better outcome compared with those with unachieved histological healing(P＜0.001)using ICEI.During a 12-month follow-up from other nine hospitals,patients with histological healing also had a lower risk of relapse than patients with unachieved histological healing.Conclusions:ICEI can be used to predict histological healing and identify patients with a risk of relapse 12 months and 18 months after clinical therapy.Therefore,ICEI provides a promising,simplified approach to monitor histological healing and to predict the prognosis of UC.

Ulcerative colitisHistological healingInflammatory cell enumeration indexPrognosis

Han Gao、Kangsheng Peng、Yadi Shi、Shenshen Zhu、Ruicong Sun、Chunjin Xu、Ping Liu、Zhi Pang、Lanxiang Zhu、Weichang Chen、Baisui Feng、Huili Wu、Guangxi Zhou、Mingsong Li、Junxiang Li、Baijing Ding、Zhanju Liu

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Center for IBD Research and Department of Gastroenterology,Shanghai Tenth People's Hospital,Tongji University School of Medicine,Shanghai 200085,China

Clinical Medicine,Sanquan College of Xinxiang Medical University,Xinxiang,Henan 453003,China

Department of Gastroenterology,The First People's Hospital of Shangqiu City Affiliated to Xinxiang Medical University,Shangqiu,Henan 476100,China

Department of Gastroenterology,Wuhu First People's Hospital,Wuhu,Anhui 241000,China

Department of Gastroenterology,Suzhou Municipal Hospital Affiliated to Nanjing Medical University,Suzhou,Jiangsu 215008,China

Department of Gastroenterology,The First Affiliated Hospital of Soochow University,Suzhou,Jiangsu 251006,China

Department of Gastroenterology,The Second Affiliated Hospital of Zhengzhou University,Zhengzhou,Henan 450014,China

Department of Gastroenterology,Zhengzhou Central Hospital Affiliated to Zhengzhou University,Zhengzhou,Henan 450000,China

Department of Gastroenterology,The Affiliated Hospital of Jining Medical College,Jining,Shandong 272004,China

Department of Gastroenterology,The Third Affiliated Hospital of Guangzhou Medical University,Guangzhou,Guangdong 510140,China

Department of Gastroenterology,Dongfang Hospital of Beijing University of Chinese Medicine,Beijing 100078,China

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National Natural Science Foundation of ChinaNational Natural Science Foundation of China

8237053282341219

2024

10.1097/CM9.0000000000003154

中华医学杂志(英文版)
中华医学会

中华医学杂志(英文版)

CSTPCD
影响因子：0.838
ISSN：0366-6999
年,卷(期)：2024.137(11)
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