| Background: Ulcerative colitis(UC)is a chronic nonspecific intestinal inflammatory disease with systemic symptoms and extraintestinal manifestations.In the active stage of UC,the number of granulocytes and monocytes/macrophages in peripheral blood is significantly higher than that in remission stage,and the activated granulocytes and monocytes stay in the blood circulation and intestinal mucosal tissue for a long time,resulting in colonic mucosal damage,persistent deterioration of the disease.In addition,in UC patients,granulocytes,monocytes/macrophages can release a large number of pro-inflammatory cytokines,leading to the further damage of epithelial cells which is able to release more pro-inflammatory cytokines,and hence,resulting in sustained high expression of pro-inflammatory cytokines in patients with UC.Selective granulocyte and monocyte apherisis(GMA)is one of the new non-drug treatments for UC in recent years.GMA can selectively reduce the increased activated granulocytes and monocytes/macrophages,eliminate pro-inflammatory factors,reduce inflammation,promote relief,and avoid adverse side effects of drug therapy.At present,studies at home and abroad have shown that the efficacy and safety of GMA are satisfactory.In this paper,we retrospectively analyzed and evaluated the effect of mucosal healing and its related enfluencing factors in patients with UC treated with GMA so as to provide reference and basis for the clinical application of GMA in the future.Objective: The purpose of this study was to evaluate the effect of mucosal healing and to explore the related factors affecting mucosal healing in patients with UC treated with GMA.Methods: The effect of mucosal healing was analyzed retrospectively in UC patients who received GMA therapy(twice a week,a total of 10 times)in our hospital from January 2017 to May 2020.According to the inclusion criteria,a total of 42 patients with active UC were included in this study,including 31 males and 11 females;the average age was 45.45±16.25 years old,ranging from 19 to 76 years old;the average weight was 70.71±12.74 kg,ranging from 49 kg to 106 kg;the average course of disease was 30.78±60.32 months;12 patients had a history of smoking(28.6%);and10 patients had a history of drinking(23.8%),6 patients(14.3%)were treated with corticosteroids orally or intravenously,and 36 patients(85.7%)were corticosteroids naive.According to Montreal classification,the patients were divided into extensive colon type(E3)in 30 cases(71.4%)and left colon type(E2)in 12 cases(28.6%).According to the clinical type of UC,the patients were divided into initial onset type in9 cases(21.4%)and chronic relapse type in 33 cases(78.6%).According to the modified Truelove and Witts disease severity classification,the patients were divided into mild type in 10 cases(23.8%),moderate type in 14 cases(33.3%),and severe type in 18 cases(42.9%).The curative effect of GMA was evaluated according to Rachmilewitz clinical activity index(CAI).CAI≤4 was regarded as clinical remission.Mayo endoscopic score(Mayo ES)was used to evaluate mucosal healing.Mucosa healing(MH)was defined as a Mayo ES value of 0 or 1 after treatment.According to whether the intestinal mucosa healed or not,the patients were divided into mucosa healing group and non-mucosa healing group.The clinical and laboratory indexes of the two groups were compared,and the relevant factors affecting mucosal healing in patients with active UC treated with GMA were analyzed.The adverse events during and after GMA treatment were recorded.IBM SPSS 26 software was used for statistical analysis.The difference was regarded as statistically significant when P<0.05.Results:1.Overall efficacy evaluation: The average CAI score in 42 patients was 8.26±4.01 before GMA therapy,and was 2.19±2.46 after GMA therapy,the CAI scores were significantly decreased before and after GMA treatment.The differences was statistically significant(P<0.01).36 patients reached clinical remission,and the clinical remission rate was 85.7%.The average Mayo ES was 2.62 ±0.492 before GMA therapy,and decreased to 1.76 ±0.958 after GMA,the difference was statistically significant(P<0.01).Mucosal healing was achieved in 17 patients,and the mucosal healing rate was 40.4%.2.Univariate analysis of clinical parameters: Univariate analysis of clinical parameters showed that there were significant differences in CAI score,Mayo ES score,lesion range and disease severity between mucosa healing group and non-mucosa healing group of UC patients(P<0.05).Compared with the mucosa healing group,the patients in non-mucosa healing group had higher CAI and Mayo ES scores,more extensive lesions and more severe disease.Univariate analysis of laboratory indexes showed that the levels of CRP,ESR and FIB were higher in the non-mucosa healing group when compared with the mucosa healing group(P<0.05).There was no difference in other clinical and laboratory variables such as sex,age,body weight,course of disease,WBC count,PLT count,HB,ALB,IL-6,IL-1 β,IL-8,IL-10,and TNF-α(P>0.05).3.Multivariate analysis of clinical parameters: Logistic regression analysis showed that the severity of the disease was an independent risk factor for mucosa healing in patients with active UC.The risk of non-mucosa healing in patients with severe UC was 16.923 times higher than that in patients with mild or moderate UC.Mayo ES score was also an independent risk factor,with an increase of every 1 point in Mayo ES resulting in an increase of the risk of non-mucosa healing by 9.606%.4.Safety of GMA therapy: No adverse reactions related to GMA therapy and no other serious adverse events were observed during and after GMA.Conclusions: GMA is an effective and safe therapy for patients with active UC with a high clinical remission rate and high mucosa healing rate;Mayo ES score and disease severity are independent risk factors affecting mucosa healing in patients with active UC;CAI score,lesion range,CRP,ESR and FIB in patients with active UC are all related factors affecting mucosa healing in patients with active UC. |
PDF Full Text Request