PREVENT試験におけるクローン病の術後の再発を評価するための内視鏡指標の信頼性と反応性
Jurij Hanzel1, Sudheer K Vuyyuru2, Brian Bressler3
1Department of Gastroenterology, UMC Ljubljana, Medical Faculty, University of Ljubljana, Ljubljana, Slovenia; Alimentiv Inc, London, Ontario, Canada.
まとめ
エンドスコープによるスコア付けは,ネオターミナル・イレウムにおける手術後のクローン病の活動を確実に評価します. しかし,その信頼性と反応性は,アナストモシスや遠大腸を評価するのに最適ではありません.
科学分野:
- 胃腸内科
- 臨床内視鏡検査
- 炎症性腸疾患の研究
背景:
- 術後のクローン病 (Crohn's disease,CD) の管理に際して,内視鏡活動の正確な評価は極めて重要です.
- 様々な内視スコアリングシステムが存在しますが,手術後の環境での比較性能は徹底的な評価を必要とします.
- PREVENT試験は,これらの機器を評価するための貴重なデータセットを提供しました.
研究 の 目的:
- 術後のCD活動評価のための複数の内視鏡機器の信頼性と応答性を包括的に評価する.
- 特定の解剖学的な部位における異なるスコアリングシステムの性能を比較する:ネオターミナル・イレウム,アナストモシス,およびディスタル・コロン.
主な方法:
- PREVENT 試験の70人の患者からの 腸内視鏡検査のビデオは 3人の盲目の読者によってレビューされました
- 病気の活性は,ラトゲルツ,改変されたラトゲルツ,POCER指数,REMINDスコア,SES- CD,CDEISを用いて評価された.
- 信頼性はクラス内相関係数 (ICC) によって測定され,応答性は勝利確率 (WinP) によって測定された.
主要な成果:
- ルートゲルツ,改変ルートゲルツ,イレアルREMIND,SES- CD,CDEISでは,相当な評価者間信頼性 (ICC 0. 74- 0. 80) と高い反応性 (WinP 0. 75- 0. 83) が認められた.
- 適度な (POCER指数) から適度な (アナストモティックREMIND) の信頼性と,POCERとアナストモティックREMINDのわずかな反応性が観察されました.
- 信頼性と反応の見積もりは,ネオターミナル・イレウムと比較して,アナストモシスとディスタル・コロンでは一貫して低かった.
結論:
- 確立された内視指標は,ネオターミナルイレウムにおける手術後のクローン病の評価のための良好な信頼性と反応性を示しています.
- これらの指標は,アナストモシスまたは遠大腸の疾患活動を評価するのに最適ではありません.
- これらの特定の術後のセグメントでは,内視鏡による評価ツールのさらなる精細化が必要になる可能性があります.
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