南方医科大学学报

南方医科大学学报 ›› 2023, Vol. 43 ›› Issue (7): 1204-1213.doi: 10.12122/j.issn.1673-4254.2023.07.17

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改进的MAYO内镜评分对活动期溃疡性结肠炎疗效有较高的评估价值

宋泽军，董海滨，马 娜，任渝棠，姜 泊   

  1. 榆林市第一医院消化内科，陕西 榆林 719000；清华大学附属北京清华长庚医院消化内科//清华大学临床医学院，北京 102218
  • 出版日期:2023-07-20 发布日期:2023-07-20

Value of Improved Mayo Endoscopic Score for evaluating treatment efficacy for active ulcerative colitis

SONG Zejun, DONG Haibin, MA Na, REN Yutang, JIANG Bo   

  1. Department of Gastroenterology, Yulin First Hospital, Yulin 719000, China; Department of Gastroenterology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing 102218, China
  • Online:2023-07-20 Published:2023-07-20

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摘要： 目的 探讨改进的Mayo内镜评分（IMES）对活动期溃疡性结肠炎（UC）疗效的评估价值。方法 选取2015年1月~2020年12月在清华大学附属北京清华长庚医院确诊为UC且完成肠镜的活动期患者，共纳入103名患者，并对这些患者进行1年的随访。内镜病变严重程度采用 Mayo 内镜评分、溃疡性结肠炎镜下严重程度指数（UCEIS）进行评估，内镜下病变范围采用Montreal分型。将MES评分同Montreal分型结合得出IMES。结果 单因素分析提示年轻（<40岁）患者、广泛病型（E3）患者、高内镜评分（MES=3、UCEIS>4、IMES>4）患者、接受高级药物治疗（全身激素、免疫抑制剂、免疫调节剂、生物制剂等）患者临床缓解、内镜缓解率更低；COX生存分析提示IMES≤4是预测取得临床缓解、内镜缓解的独立危险因素；ROC曲线提示IMSE≤4对患者取得临床缓解、内镜缓解的预测价值（AUC=0.7793、0.7095，P<0.01）优于Montreal为E1/2（AUC=0.7357、0.6847，P<0.01）、MES=2（AUC=0.6671、0.5929，P<0.01）、UCEIS≤4（AUC=0.6823、0.6459，P<0.01）；IMES=5对活动期UC患者接受结肠切除手术具有较好的预测价值，优于E3、MES=3。结论 IMES能够对活动期溃疡性结肠炎的疗效有较好的评估价值。

关键词: 内镜检查；评分；溃疡性结肠炎；疗效

Abstract: Objective To assess the value of Improved Mayo Endoscopic Score (IMES) for evaluation of treatment efficacy for active ulcerative colitis (UC). Methods We retrospectively analyzed the clinical and endoscopic data of 103 patients diagnosed with active UC in Beijing Tsinghua Changgung Hospital from January, 2015 to December, 2020. The severity of endoscopic lesions was determined by Mayo Endoscopic Score and the Ulcerative Colitis Endoscopic Index of Severity (UCEIS), and the area of the endoscopic lesions was evaluated based on the Montreal classification system. The IMES was established by combining the MES with the Montreal classification. Results Univariate analysis suggested that young patients (<40 years old), patients with extensive disease type (E3), patients with high endoscopic scores (MES=3, UCEIS>4, and IMES>4), and patients receiving advanced drug therapy (with systemic hormones, immunosuppressants, immunomodulators, and biological agents, etc.) had lower clinical and endoscopic remission rates. COX survival analysis showed that IMES≤4 was an independent risk factor for clinical and endoscopic remission. ROC curve indicated that the predictive value of IMSE≤4 for clinical and endoscopic remission (AUC=0.7793 and 0.7095, respectively; P<0.01) was better than that of Montreal (AUC=0.7357 and 0.6847, respectively; P<0.01), MES=2 (AUC=0.6671 and 0.5929, respectively; P<0.01), and UCEIS≤4 (AUC=0.6823 and 0.6459, respectively; P<0.01); IMES=5 had a better predictive value for patients with active UC undergoing colectomy tham E3 and MES=3. Conclusion IMES has good value in evaluating treatment efficacy for active UC.

Key words: endoscopy; score; ulcerative colitis; efficacy