Mayo scoreによる潰瘍性大腸炎のmucosal healingと病理組織学的活動性との相関  [in Japanese] Correlation between endoscopic healing and histological healing of ulcerative colitis determined using the Mayo score  [in Japanese]

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Author(s)

    • 安達 世 Adachi Sei
    • 東京慈恵会医科大学附属柏病院/内視鏡部消化器肝臓内科 Department of Endoscopy, The Jikei University Kashiwa Hospital
    • 湯川 豊一 Yukawa Toyokazu
    • 東京慈恵会医科大学附属柏病院/内科学講座消化器肝臓内科 Department of Gastroenterogy and Hepatorogy, The Jikei University Kashiwa Hospital
    • 梶原 幹生 Kajihara Mikio
    • 東京慈恵会医科大学附属柏病院/内科学講座消化器肝臓内科 Department of Gastroenterogy and Hepatorogy, The Jikei University Kashiwa Hospital
    • 内山 幹 Uchiyama Kan
    • 東京慈恵会医科大学附属柏病院/内科学講座消化器肝臓内科 Department of Gastroenterogy and Hepatorogy, The Jikei University Kashiwa Hospital
    • 小井戸 薫雄 Koido Shigeo
    • 東京慈恵会医科大学附属柏病院/内科学講座消化器肝臓内科 Department of Gastroenterogy and Hepatorogy, The Jikei University Kashiwa Hospital
    • 大草 敏史 Ohkusa Toshifumi
    • 東京慈恵会医科大学附属柏病院/内科学講座消化器肝臓内科 Department of Gastroenterogy and Hepatorogy, The Jikei University Kashiwa Hospital
    • 田尻 久雄 Tajiri Hisao
    • 東京慈恵会医科大学附属病院/内科学講座消化器肝臓内科 Department of Gastroenterogy and Hepatorogy, The Jikei University Hospital
    • 荒川 廣志 Arakawa Hiroshi
    • 東京慈恵会医科大学附属柏病院/内視鏡部消化器肝臓内科 Department of Endoscopy, The Jikei University Kashiwa Hospital
    • 小山 誠太 Koyama Seita
    • 東京慈恵会医科大学附属柏病院/内視鏡部消化器肝臓内科 Department of Endoscopy, The Jikei University Kashiwa Hospital
    • 斉藤 恵介 Saito Keisuke
    • 東京慈恵会医科大学附属柏病院/内視鏡部消化器肝臓内科 Department of Endoscopy, The Jikei University Kashiwa Hospital
    • 伊藤 善翔 Ito Zensho
    • 東京慈恵会医科大学附属柏病院/内科学講座消化器肝臓内科 Department of Gastroenterogy and Hepatorogy, The Jikei University Kashiwa Hospital
    • 松本 善弘 Matsumoto Yoshihiro
    • 東京慈恵会医科大学附属柏病院/内科学講座消化器肝臓内科 Department of Gastroenterogy and Hepatorogy, The Jikei University Kashiwa Hospital
    • 高倉 一樹 Takakura Kazuki
    • 東京慈恵会医科大学附属柏病院/内科学講座消化器肝臓内科 Department of Gastroenterogy and Hepatorogy, The Jikei University Kashiwa Hospital
    • 月永 真太郎 Tsukinaga Shintaro
    • 東京慈恵会医科大学附属柏病院/内科学講座消化器肝臓内科 Department of Gastroenterogy and Hepatorogy, The Jikei University Kashiwa Hospital
    • 小田原 俊一 Odahara Shunichi
    • 東京慈恵会医科大学附属柏病院/内科学講座消化器肝臓内科 Department of Gastroenterogy and Hepatorogy, The Jikei University Kashiwa Hospital

Abstract

Mayo scoreを用いて潰瘍性大腸炎(UC)の内視鏡的粘膜治癒と病理組織学的(以下,組織学的)治癒の相関を検討した。また血便の再出現を再発と定義し,両治癒における再発率を検討した。2013年8月〜2014年2月までに当院内視鏡室で大腸内視鏡検査(CS)を施行したUC患者50例を対象とした。CSは全例一人の内視鏡医が施行し,虫垂開口部から直腸まで大腸7区分の内視鏡的活動性スコア(endoscopic score : ES)を評価した。また全区分より生検を施行し,同一部位の病理組織学的活動性スコア(histological score : HS,以下,組織スコア)を評価した。内視鏡的治癒は内視鏡スコアの0と1,組織学的治癒は組織スコアの0と1と定義した。対象50例は平均年齢45歳で軽症と全結腸型が最も多かった。350部位(50例×7区分)のうち,93.4%が内視鏡的治癒,81.7%が組織学的治癒と診断された。内視鏡的治癒の85.6%は組織学的治癒であったが,14.4%で両者が乖離していた。内視鏡的治癒37例のうち再発は,組織学的治癒で12.5%(3/24),組織学的非治癒では30.8%(4/13)と高い再発率を認めた。組織学的治癒26例のうち全区分で組織スコア0の症例で再発を認めなかったが,組織スコア1の症例では再発を18.8%に認めた。内視鏡的治癒の14.4%に組織学的活動性炎症を認め,組織学的非治癒症例は再発率が高かったことから,粘膜治癒の評価については内視鏡的粘膜治癒だけでなく組織学的治癒の重要性が示唆された。

Mucosal healing (MH) is thought to be the endpoint of therapy in patients with ulcerative colitis (UC) . Endoscopic mucosal healing is currently considered as an optimal indicator of mucosal healing, however, it is still not clear whether endoscopic mucosal healing concurs with histological mucosal healing. We investigated the correlation between endoscopic healing and histological healing using Mayo endoscopic subscores and Sandborn's histological scores, and also comparatively investigated the incidence of relapse of UC in patients with endoscopic MH and histological MH. Fifty patients with UC underwent complete colonoscopy by the same endoscopist, and each of seven colonic segments were evaluated prospectively using the Mayo endoscopic subscores (grade 0-3) . Biopsies were also performed in the same colonic segments and evaluated by the Sandborn's histology scores (grade 0-4) . Endoscopic MH was defined as Mayo score 0 or 1, and histological MH was defined as Sandborn's score 0 or 1. Relapse was defined as recurrence of overt hematochezia. Endoscopic MH was found in 93.4%, and histologic MH in 82.2% of the total of 350 colonic segments. Among all the segments showing endoscopic MH, 85.6% also showed histological MH, while the remaining 14.4% showed histological active inflammation. Of 37 patients with endoscopic MH, the incidence of relapse was higher in the histological non-MH patients (30.8%) than in the histological MH patients (12.5%) . No cases of relapse were found among the patients with a histological score of 0 in all the colonic segments, whereas 18% of those with a histological score of 1 in any of the colonic segments developed relapse. There was a dissociation between endoscopic and histological mucosal healing, and histological mucosal healing may represent true healing rather than endoscopic mucosal healing, and may need to be considered as the ultimate goal of treatment in patients with UC.

Journal

  • Progress of Digestive Endoscopy

    Progress of Digestive Endoscopy 85(1), 43-46, 2014

    Japan Gastroenterological Endoscopy Society Kanto Chapter

Codes

  • NII Article ID (NAID)
    130004985562
  • Text Lang
    JPN
  • ISSN
    1348-9844
  • Data Source
    J-STAGE 
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