Effects Of Traditional Therapy And Biological Agents On Mucosal Healing And Recurrence Of Moderate And Severe Ulcerative Colitis

Background: The therapeutic goal of Ulcerative Colitis(UC)has evolved into clinical remission and deep remission of mucosal healing,while the treatment of moderate and severe UC remains challenging to achieve.In recent years,biologics have become the first choice for the treatment of moderate and severe UC,and the comparison between the efficacy of biologics and traditional drugs has become a hot research topic.In addition,in order to improve the standard treatment rate of moderate and severe UC,it is also very important to identify the related factors affecting mucosal healing.Objective:Patients diagnosed with moderate to severe UC in the Second Affiliated Hospital of Dalian Medical University were selected as the research objects.Retrospective analysis was conducted on the difference of clinical efficacy between traditional therapy and biologic therapy in patients with moderate and severe UC within1 year,as well as the correlation between mucosal healing and recurrence,and further discussion was made on the related factors affecting the mucosal healing of moderate and severe UC before induction therapy,in order to provide reference for standard treatment management.Methods:Patients diagnosed with moderate to severe UC in the Second Affiliated Hospital of Dalian Medical University from September 2008 to April 2022 were included.1.Patients were divided into the traditional treatment group and the biological preparation group,and the differences in clinical remission,mucosal healing,deep remission and recurrence were analyzed between the two groups.2.According to endoscopic Mayo score after treatment,patients were divided into mucosal healing group and mucosal unhealing group,and the correlation between mucosal healing and recurrence was analyzed.3.Gender,age,BMI,clinical type,lesion range,therapeutic drugs,laboratory indexes and other data of patients in the mucosal healing group and the mucosal unhealing group were further analyzed to explore the related factors affecting mucosal healing in patients with moderate and severe UC before induction therapy.Results: 1.Analysis of efficacy of traditional drugs and biologics in the treatment of moderate and severe UC: 1)Analysis of general data: a total of 105 cases,63 cases in the traditional treatment group and 42 cases in the biologics group.There were no significant differences in gender,age,BMI,course of disease and other general data between the two groups.2)Analysis of clinical characteristics: Clinical classification:22 cases(34.9%)of primary type in traditional treatment group,41 cases(65.1%)of chronic recurrence type,7 cases(16.7%)of biological agents group,35 cases(83.3%).Lesions range: 16 cases(25.4%)of rectal type,23 cases(36.5%)of left half colon type and 24 cases(38.1%)of extensive colon type in the traditional treatment group,and 1case(2.4%),5 cases(11.9%)and 36 cases(85.7%)in the biological agent group,respectively.Pre-treatment Mayo score: 11(10,11)in the conventional treatment group and 9(8,11)in the biologics group.Compared with the traditional treatment group,the biologics group had a higher proportion of chronic recurrence and extensive colonotype,and a higher Mayo score before treatment,indicating that the biologics group had a wider range of lesions and a more severe disease degree.The differences were statistically significant.3)Analysis of clinical efficacy: Within 1 year,there were 6cases of clinical remission(9.5%),8 cases of mucosal healing(12.7%)and 6 cases of deep remission(9.5%)in the traditional treatment group,and 23 cases(54.8%),23 cases(54.8%)and 22 cases(52.4%)in the biological agent group,respectively.The clinical remission rate,mucosal healing rate and deep remission rate in the biologics group were significantly higher than those in the traditional treatment group,with statistical significance.4)Analysis of recurrence: 55 cases(87.3%)recurred in the traditional treatment group within 1 year,including 16 cases(25.4%)of early recurrence,30 cases(47.6%)of occasional recurrence and 19 cases(30.2%)of frequent recurrence.In the biologic treatment group,21 cases(50.0%)relapsed,including 8 cases(19.0%)of early recurrence,6 cases(14.3%)of occasional recurrence and 13 cases(31.0%)of frequent recurrence.The recurrence rate and incidence rate in the biologics group were lower than those in the traditional treatment group,and the difference was statistically significant.2.Correlation analysis between mucosal healing and recurrence: 1)Analysis of general data: 74 cases of mucosal unhealing group and 31 cases of mucosal healing group.There were no significant differences in gender,age,BMI,course of disease and other general data between the two groups.2)Correlation analysis: 68 cases(91.9%)recurred in the mucosa healing group and 8 cases(25.8%)in the mucosa healing group.Among the different treatment groups,in the traditional treatment group,52 cases(94.5%)of the 55 patients with non-healing mucosa recurred,and 3 cases(37.5%)of the 8 patients with healing mucosa recurred.In the biologics group,16 patients(84.2%)and 5 patients(21.7%)of 19 patients with unhealed mucosa relapsed.The recurrence rate of unhealed mucosa group was higher than that of healed mucosa group,and the differences were statistically significant.3.Analysis of influencing factors of mucosal healing: 1)Univariate analysis: lesion range,therapeutic drugs,ESR,HB were correlated with mucosal healing,and the results were statistically significant.2)Multivariate analysis: The inclusion of lesion range,therapeutic drugs,ESR and HB in multivariate analysis showed that biologic therapy was an independent protective factor for mucosal healing,and ESR≥20mm/h was an independent risk factor for mucosal healing.Conclusion:Biologics have better effect on moderate and severe UC,with higher clinical remission rate,mucosal healing rate and deep remission rate,and lower recurrence rate.There is a correlation between mucosal healing and relapse in patients with moderate and severe UC,and achieving mucosal healing can significantly reduce the risk of relapse.ESR≥20mm/h,moderate and severe UC patients have difficulty in achieving mucosal healing efficacy,and more active treatment plans should be selected.Compared with traditional therapy,biologics are more beneficial in achieving mucosal healing,thereby reducing relapse and improving quality of life in patients with moderate to severe UC.