Supplementary Material for: Milan Ultrasound Criteria predict relapse of ulcerative colitis in remission

Introduction Bowel ultrasound is a non-invasive alternative to endoscopy for assessing the disease activity of ulcerative colitis; however, it is unclear whether bowel ultrasound can predict subsequent relapse from remission. Materials and Methods A retrospective cohort study enrolled patients with ulcerative colitis who underwent bowel ultrasound between July 2018 and July 2021 during clinical remission (patient-reported outcome-2 ≤ 1 and no rectal bleeding) for at least 3 months and were followed up for 1 year. Ultrasonographic findings (bowel wall thickness, bowel wall flow, bowel wall stratification, and enlarged lymph nodes), Milan Ultrasound Criteria, Mayo endoscopic subscore, C-reactive protein, and fecal calprotectin levels and their association with subsequent clinical relapse were assessed. Relapse was defined as rectal bleeding score ≥ 1, stool frequency score ≥ 2, or treatment intensification for symptoms. Results 31% of the patients (18/58) relapsed within 1 year. No single ultrasonographic finding predicted relapse, whereas Milan Ultrasound Criteria > 6.2 (p = 0.019), Mayo endoscopic subscore ≥ 1 (p = 0.013), and fecal calprotectin ≥ 250 μg/g (p = 0.040) were associated with a shorter time to relapse in the log-rank test. Milan Ultrasound Criteria > 6.2 (hazard ratio 3.22; 95% confidence interval 1.14-9.08, p = 0.027) and Mayo endoscopic subscore ≥ 1 (hazard ratio 8.70; 95% confidence interval 1.11-68.1, p = 0.039) showed a higher risk of relapse according to a Cox proportional hazards model. Discussion/Conclusion Bowel ultrasound can predict subsequent clinical relapse from remission in patients with ulcerative colitis using the Milan Ultrasound Criteria.

引言：肠道超声（bowel ultrasound）是内镜检查之外用于评估溃疡性结肠炎（Ulcerative Colitis）疾病活动度的无创替代手段，但目前尚不明确肠道超声能否预测溃疡性结肠炎患者从临床缓解期后续的疾病复发。
材料与方法：本研究为回顾性队列研究，纳入2018年7月至2021年7月期间、处于临床缓解期[患者报告结局-2（PRO-2）评分≤1且无直肠出血]且该缓解状态持续至少3个月，并接受肠道超声检查的溃疡性结肠炎患者，随访时长为1年。本研究评估了超声影像学表现指标，包括肠壁厚度、肠壁血流信号、肠壁分层状态及肿大淋巴结，同时评估了米兰超声评分（Milan Ultrasound Criteria）、梅奥内镜亚评分（Mayo endoscopic subscore）、C反应蛋白（C-reactive protein）及粪便钙卫蛋白（fecal calprotectin）水平，并分析上述指标与后续临床复发的相关性。本研究将复发定义为：直肠出血评分≥1、排便频率评分≥2，或因症状加重需升级治疗方案。
结果：58例患者中31%（18/58）在1年内出现疾病复发。单一超声影像学指标无法独立预测疾病复发，但经log-rank检验分析显示，米兰超声评分＞6.2（p=0.019）、梅奥内镜亚评分≥1（p=0.013）及粪便钙卫蛋白≥250μg/g（p=0.040）均与更短的复发时间显著相关。经Cox比例风险模型分析，米兰超声评分＞6.2（风险比3.22；95%置信区间1.14~9.08，p=0.027）与梅奥内镜亚评分≥1（风险比8.70；95%置信区间1.11~68.1，p=0.039）均提示更高的疾病复发风险。
讨论与结论：通过米兰超声评分，肠道超声可有效预测溃疡性结肠炎患者从临床缓解期出现的后续疾病复发。