Gut: 在Crohn病监控中，内镜、断层影像和生物标记物发挥的作用

幸福侠侣

摘要：

胃肠道慢性炎症导致的肠道组织损伤是Crohn病特征性表现，该慢性炎性可伴随或不伴随复发，并且造成累积性损伤。在Crohn病的治疗方案中，有两个重要方向，即以防止组织损伤为目的的治疗措施和在整个病程中争取最佳收益/风险比。几十年以来，临床表现是指导诊断性操作和调整治疗方法的主要依据。然而，症状和肠道损伤程度之间的关联性很弱。因此，初步证据提示，除了单纯控制临床症状以外，维持疾病的缓解状态可能有更好的预后，缓解状态包括粘膜修复。从而，业内人士提议使用内镜和断层影像技术来监测Crohn病。但由于种种原因，这两种技术未能成为病患们的首选方法，原因包括：技术本身的费用和操作侵入性，以及提高预后所需要的粘膜和肠壁修复程度未得到充分的研究。使用生物标记物反映肠道和全身炎症可能有帮助。在Crohn病诊治中广泛运用的标记物有：C反应蛋白和粪钙网蛋白。这两种标记物不仅与内镜下损伤相关性很强，而且还与复发危险程度、治疗效果相关。所以它们可以帮助医生做出诊断和治疗的决策。通过运用合适的标记物浓度界值，我们可以通过标记物来决定是否需要内镜或影像学方法确定疾病状态。

原文阅读：Role of endoscopy, cross-sectional imaging and biomarkers in Crohn's disease monitoring.

Abstract

Crohn's disease is characterised by recurrent and/or chronic inflammation of the gastrointestinal tract leading to cumulative intestinal tissue damage. Treatment tailoring to try to prevent this tissue damage as well as achieve optimal benefit/risk ratio over the whole disease course is becoming an important aspect of Crohn's disease management. For decades, clinical symptoms have been the main trigger for diagnostic procedures and treatment strategy adaptations. However, the correlation between symptoms and intestinal lesions is only weak. Furthermore, preliminary evidence suggests that a state of remission beyond the simple control of clinical symptoms, and including mucosal healing, may be associated with better disease outcome. Thereforemonitoring the disease through the use of endoscopy and cross-sectional imaging is proposed. However, the degree of mucosal or bowel wall healing that needs to be reached to improve disease outcome has not been appropriately studied. Furthermore, owing to their invasive nature and cost, endoscopy and cross-sectional imaging are not optimal tools for the patients or the payers. The use of biomarkers as surrogate markers of intestinal and systemic inflammation might help. Two biomarkers have been most broadly assessed in Crohn's disease: C-reactive protein and faecal calprotectin. These markers correlate significantly with endoscopic lesions, with the risk of relapse and with response to therapy. They could be used to help make decisions about diagnostic procedures and treatment. In particular, with the use of appropriate threshold values, they could determine the need for endoscopic or medical imaging procedures to confirm the disease activity state.