简化激光共聚焦显微内镜愈合评分对溃疡性结肠炎深度愈合的诊断价值

Diagnostic value of a simplified confocal laser endomicroscopy healing score for deep remission in ulcerative colitis

摘要:

目的 建立简化激光共聚焦显微内镜（confocal laser endomicroscopy，CLE）愈合评分，用于辅助诊断溃疡性结肠炎（ulcerative colitis，UC）深度愈合。方法 回顾2017年1月至2019年12月在北京大学第一医院接受CLE检查的缓解期或轻度活动期连续UC患者和同期健康体检者CLE图像。按照UC患者病历资料中炎症受累肠段的诊断记录，将所有CLE图像分为受累组（炎症受累肠段）和对照组（健康体检者肠段和炎症未受累肠段）。筛选出两组出现率存在差异的UC典型CLE图像指标，通过单因素回归分析得出与组织学炎症（Geboes评分>2.0分）相关的指标，组成简化CLE愈合评分并绘制受试者工作特征（receiver operator characteristic，ROC）曲线。结果 53例UC患者和同期14例健康体检者最终纳入研究，共计201段CLE图像，其中健康体检者肠段图像42段，炎症未受累肠段图像69段，炎症受累肠段图像90段。受累组与对照组相比，8项指标出现率差异有统计学意义（P<0.001），包括腺体变形、腺管变形、腺体邻近、腺体稀疏、腺管荧光、血管荧光、血管增粗和细胞浸润。单因素回归分析显示，腺体变形（P=0.025， OR=3.613， 95%CI： 1.174~11.114）、腺管变形（P=0.021，OR=4.081，95%CI：1.233~13.511）、腺管荧光（P=0.011，OR=5.486，95%CI：1.468~20.494）和血管增粗（P=0.002，OR=7.724，95%CI：2.062~28.938）与组织学炎症相关。将这4项指标组合形成简化CLE愈合评分并绘制ROC曲线，曲线下面积为0.769（95%CI：0.654~0.833）。以4项指标均未出现（0分）判断为组织学愈合，其判断敏感度和特异度分别为83.1%（59/71）和42.1%（8/19）。结论 简化CLE愈合评分与UC组织学愈合有很高的相关性，其判断敏感度高，可作为UC深度愈合判定过程中重要的辅助检查。

Abstract:

Objective To develop a simplified confocal laser endomicroscopy (CLE)‑based healing scoring system for assistant diagnosis of deep remission in ulcerative colitis (UC). Methods CLE images from consecutive UC patients in clinical remission or mild activity and healthy controls undergoing CLE at Peking University First Hospital from January 2017 to December 2019 were retrospectively analyzed. According to the diagnosis of inflammation in intestinal segments in the medical records of UC patients, CLE images were divided into two groups, the involved group (inflamed UC segment) and the control group (segments from healthy individuals and non‑inflamed UC segments). CLE features differentiating the groups were identified, and univariable regression analysis was used to obtain indicators related to unhealed histological inflammation (Geboes score>2.0), forming a simplified CLE healing score using the significant indicators, and receiver operator characteristic (ROC) curve was drawn. Results The study included 53 UC patients and 14 healthy controls, yielding 201 CLE segments (42 healthy, 69 non‑inflamed, 90 inflamed). Eight CLE features differed significantly between the involved and the control groups (P<0.001), including crypt distortion, crypt lumen irregularity, crypt proximity, crypt sparsity, crypt lumen fluorescein leakage, vascular fluorescein leakage, increased vessel diameter, and cellular infiltration. Univariable regression analysis indicated there were 4 indicators related to histological inflammation, including crypt distortion (P=0.025, OR=3.613, 95%CI:1.174‑11.114), crypt lumen irregularity (P=0.021, OR=4.081, 95%CI: 1.233‑13.511), crypt fluorescein leakage (P=0.011, OR=5.486, 95%CI: 1.468-20.494) and increased vessel diameter (P=0.002, OR=7.724, 95%CI: 2.062‑28.938). These 4 indicators were combined to form a simplified CLE healing score and a ROC curve was plotted with AUC of 0.769 (95%CI:0.654‑0.833). The optimal threshold for histological healing was the absence of all four features (score=0), with sensitivity and specificity of 83.1% (59/71) and 42.1% (8/19), respectively. Conclusion The simplified CLE score demonstrates high sensitivity and correlates positively with histological healing, supporting its utility as an adjunct tool for assessing deep remission in UC.