Correlation Between Blood Biomarkers And Histological Inflammation In Ulcerative Colitis

Background and Purpose:Ulcerative colitis(UC)is one of the types of inflammatory bowel disease(IBD).The inflammation is often confined to the mucosal layer and is a progressive,wasting intestinal disease.In recent years,the continuous development of China’s economy has led to the increasing incidence of UC,and the disease phenotype and intestinal muscle nerve of inflammatory injury may change,accompanied by systemic symptoms and parenteral manifestations,and even associated with the risk of colorectal cancer.In severe cases,colorectal resection is required.The long-term decline in quality of life is also likely to induce mental illness in patients.We found that good mucosal histological healing was associated with better clinical outcomes.The gold standard for determining the histology of UC is the combination of endoscopy and pathological biopsy,but endoscopy is an invasive examination,and the patient’s compliance with frequent endoscopic review is poor,and some primary medical care cannot meet the conditions of endoscopy,and endoscopy cannot be performed in patients accompanied by intestinal stenosis or toxic megacolon.Although UC is a progressive disease,the loss accumulated over time cannot be evaluated clinically.Therefore,monitoring of targeted treatment during the course of the disease can predict the progression of the disease,help select the appropriate treatment and achieve histological healing as soon as possible.Therefore,it is important to explore clinically applicable non-invasive tests to monitor UC histological activity and disease severity.Serological markers are commonly used indicators for UC monitoring.Studies have confirmed that C-reactive protein(CRP),Albumin(ALB),neutrophils and platelets are all related to UC mucosal healing(MH),but lack specificity.In recent years,it has been found that C-reactive protein to albumin ratio(CAR)and Systemic immune-inflammation index,SⅡ is a new marker closely related to the evaluation of alignant tumors,kidney inflammation and other diseases,and its price is reasonable and easy to promote.UC is a chronic recurrent intestinal mucosal inflammatory disease,and whether the degree of histological inflammation is related to the above indicators that can reflect the systemic immune status is worth exploring.In this paper,a large number of clinical data of patients diagnosed with ulcerative colitis in our hospital were retrospectively studied,and the application value of CRP,CAR and SⅡ in the evaluation of UC mucosal histological activity and inflammation severity was analyzed and discussed comprehensively,which brought more significance to the clinical monitoring and treatment of UC.Materials and methods:1.Subjects: Inpatients with ulcerative colitis diagnosed in the Department of Gastroenterology of the First Affiliated Hospital of Henan University from October 2017 to February 2023 according to Consensus on Diagnosis and Treatment of Inflammatory Bowel Disease.2.Data collection: After appropriate inclusion and exclusion criteria,a total of 116 patients with ulcerative colitis were screened.The patients’ blood routine,biochemical indicators,erythrocyte sedimentation rate,gastrointestinal endoscopy results,clinical symptoms,and medication history were collected.According to Nancy’s score,UC patients were divided into the histological remission group(0-1)and the histological active group(2-4).The histological active group was divided into a mild active group(2),a moderate active group(3),and a severe active group(4).The clinical characteristics of each group were compared.Combined with laboratory examination,the levels of CAR and SⅡ in each group were calculated,and the values of CAR,SⅡ,and CRP in distinguishing the histological active stage from the remission stage,mild,moderate and severe histological active stage were analyzed,and the correlation between CAR,SⅡ,CRP and Nancy score was analyzed.Results:(1)General information: A total of 116 UC patients were enrolled.According to Nancy’s score,there were no significant differences in age,gender,and course of disease between the groups(P=0.052,0.329,and 0.174).(2)The CRP,CAR and SⅡ in the histological activity group were significantly higher than those in the histological remission group,and the difference was statistically significant(P < 0.01).(3)There were significant differences in CRP,CAR and SⅡ among the remission group,mild,moderate and severe activity group(P < 0.001).After pairwise comparison,CRP,CAR and SⅡ in the histological remission group were lower than those in the histological mild active group(P < 0.05).The levels of CRP,CAR and SⅡ in the mild active group were lower than those in the moderate active group and the severe active group,and the differences were statistically significant(P < 0.05).(4)The best cutoff values of SⅡ,CRP and CAR were 585.52,3.51mg/L and 0.09 for predicting the histological activity of UC.The area under the curve of SⅡ was larger than that of CRP and CAR,the sensitivity was higher(SEV%=66.0),and the specificity was slightly lower than CRP and CAR.The area under the curve of SⅡ+CAR+CRP was larger,and the area under the curve,sensitivity,specificity and95%CI were 0.848,67.0%,90.9% and 0.771 to 0.925,respectively.(5)Red blood cell(Rs=-0.220,P=0.018),hemoglobin(Rs=-0.256,P=0.006),and albumin(Rs=-0.256,P=0.005)were negatively correlated with Nancy score,and all of them were statistically significant;White blood cell(Rs=0.478,P < 0.001),platelet(Rs=0.369,P < 0.001),neutrophil(Rs=0.569,P < 0.001),SⅡ(Rs=0.646,P < 0.001),CRP(Rs=0.520,P < 0.001),CAR(Rs=0.523,P < 0.001)were positively correlated with Nancy score,and all of them were statistically significant.Frequency of diarrhea(Rs=0.165,P=0.177)were positively correlated,but no statistical significance was found.Conclusion:1.The levels of C-reactive protein(CRP),C-reactive protein/albumin(CAR),and systemic immune inflammation index(SⅡ)in UC patients with histologically active stage were higher than those in the histological remission group,and it increased with the severity of histological inflammation.2.CRP,CAR,and SⅡ can all predict the histological activity of UC,and can be used as a supplementary method for disease monitoring of UC.The sensitivity of SⅡ was the highest when detecting single item.The combined detection of SⅡ,CRP,and CAR can improve the sensitivity,and the efficacy is better than each single test.