摘要
Background:Ulcerative colitis(UC)is a chronic lifelong disease.The disease extent of UC can progress over time.This study aimed to assess whether cumulative inflammatory burden(CIB)is associated with disease extension in distal UC(proctitis[E1]and left-sided colitis[E2])patients,and to develop a quantified indicator of CIB.Methods:In this retrospective study based on a prospective registry,distal UC patients receiving colonoscopies in Xijing Hospital(Xi’an,China)fromJanuary 2000 to May 2019 were studied.We developed a new score,namely the time-adjusted average Mayo endoscopic score(TA-MES),calculated as dividing the sum of the cumulative averageMES over a period of surveillance time by the length of the endoscopic examination interval,to quantify the CIB.Cox regression was used to identify other potential risk factors.Results:A total of 295 UC patients were followed for 1,487.02 patient-years.Among them,140 patients(47.5%)experienced disease extension.Multivariate analysis showed that the TA-MES was significantly associated with disease extension in E1(hazard ratio[HR],2.90;95%confidence interval[CI],1.58–5.33,P=0.001)and E2(HR,1.89;95%CI,1.16–3.09,P=0.011)patients.Other risk factors included hemoglobin of<90 g/L and appendiceal skip inflammation;the protective factors included age,E2 at diagnosis,former smoking,and 5-aminosalicylic acid dose.Otherwise,MES at diagnosis,maximal MES,and mean MES failed to estimate the risk of disease extension.Conclusion:TA-MES is a good quantified indicator of CIB and is independently associated with increased disease extension in distal UC patients.Whether the dynamic multiple scoring system could be used as a risk factor in other chronic relapsing–remitting diseases is a direction for future research.
基金
supported by the National Natural Science Foundation of China[grant numbers 81421003,81627807,81772650,81322037,81572302]
National Key Research and Development Plan of China[grant number 2017YFC0908300]
Independent Funds of the Key Laboratory[grant number CBSKL2015Z01].
