Clinical Gastroenterology and Hepatology最新文献

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Large-scale Clustering of Longitudinal Fecal Calprotectin and C-reactive Protein Profiles in Inflammatory Bowel Disease. 炎症性肠病中纵向粪便钙保护蛋白和c反应蛋白谱的大规模聚类。

IF 12 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Clinical Gastroenterology and Hepatology

Pub Date : 2025-12-29 DOI: 10.1016/j.cgh.2025.12.022

Nathan Constantine-Cooke, Marie Vibeke Vestergaard, Nikolas Plevris, Karla Monterrubio-Gómez, Clara Ramos-Belinchón, Solomon Ong, Alexander T Elford, Beatriz Gros, Aleksejs Sazonovs, Gareth-Rhys Jones, Tine Jess, Catalina A Vallejos, Charlie W Lees

Background & aims: Crohn's disease and ulcerative colitis are highly heterogeneous, dynamic, and unpredictable, with a marked disconnect between symptoms and intestinal inflammation. We aimed to describe latent disease heterogeneity in inflammatory bowel disease (IBD) by identifying longitudinal fecal calprotectin (FC) and C-reactive protein (CRP) patterns.

Methods: In this longitudinal study, patient-level measurements of FC and CRP in 2 European cohorts were modeled. Latent class mixed models were used to cluster individuals with similar longitudinal profiles. Associations between cluster assignment and baseline characteristics were quantified using multinomial logistic regression. Differences in advanced therapy use across clusters were explored. Finally, we considered the overlap between FC and CRP clusters.

Results: We included 1036 patients in the FC discovery analysis (Lothian) with a total of 10545 FC observations (median, 9 per subject; interquartile range, 6-13), and 7880 patients in the replication (Denmark). The CRP discovery analysis consisted of 1838 patients with 49364 measurements (median, 20 per subject; interquartile range, 10-36), with 10,041 patients in the replication cohort. Eight distinct clusters of inflammatory behavior over time were identified in the FC and CRP analysis. Similar patterns were observed in the replication cohort. The clusters included rapid remitters, delayed remitters, remitting-relapsing disease, and non-remitters. The highest use of early advanced therapy was in the group with the lowest overall inflammation. There was broadly poor agreement between FC and CRP cluster assignment.

Conclusions: Distinct patterns of inflammatory behavior over time are evident in patients with IBD. These data pave the way for a deeper understanding of disease heterogeneity in IBD.

背景和目的：克罗恩病（CD）和溃疡性结肠炎（UC）是高度异质性、动态和不可预测的，症状和肠道炎症之间存在明显的脱节。我们的目的是通过确定纵向粪便钙保护蛋白（FC）和CRP模式来描述IBD的潜伏性疾病异质性。方法：在这项纵向研究中，对两个欧洲队列中患者水平的FC和CRP测量进行了建模。潜在类混合模型用于聚类具有相似纵向分布的个体。聚类分配和基线特征之间的关联使用多项逻辑回归进行量化。探讨了不同集群间高级治疗使用的差异。最后，我们考虑了FC和CRP簇之间的重叠。结果：我们在FC发现分析（洛锡安）中纳入了1036例患者，共有10545例FC观察（平均每个受试者9例，IQR 6-13），在复制中纳入了7880例患者（丹麦）。CRP发现分析包括1838例患者，49364次测量（中位20例/受试者；IQR为10-36），其中10041例患者在重复队列中。随着时间的推移，在FC和CRP分析中确定了8种不同的炎症行为。在重复队列中也观察到类似的模式。这些组群包括快速缓解者、延迟缓解者、缓解复发疾病者和非缓解者。在总体炎症最低的组中，早期晚期治疗的使用率最高。FC和CRP聚类分配的一致性很差。结论：随着时间的推移，炎症行为的不同模式在IBD患者中很明显。这些数据为更深入地了解IBD的疾病异质性铺平了道路。

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引用次数: 0

Is it Time to Treat to Histologic Remission Yet? 现在是治疗组织学缓解的时候了吗？

IF 12 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Clinical Gastroenterology and Hepatology

Pub Date : 2025-12-29 DOI: 10.1016/j.cgh.2025.12.023

David T Rubin, Navneet K Natt

引用次数: 0

Week 12 Reduction in MM-SES-CD is Predictive of Delayed Response to Upadacitinib in Crohn’s disease 第12周MM-SES-CD降低可预测克罗恩病对Upadacitinib的延迟反应