Reezwana Chowdhury博士:在缓解方面。我认为我们使用了各种因素。一个是明显的临床症状，我们有一个临床疾病活动指数，我们通常喜欢在每次访问时观察。所以在诊所就诊时，我们会问这些客观参数方面的问题，比如观察某人的炎症标志物，比如他们的CRP, ESR或粪便钙保护蛋白。很明显，我们会用活组织检查做结肠镜检查。第一，用内窥镜检查他们以前是否有溃疡或严重的炎症。他们的结肠看起来比以前好了没有溃疡，没有粘连了吗?看起来就像一个从没得过病的人。这是可以实现的。在我们考虑内窥镜缓解的时候。 And then if someone’s had small bowel disease and MRI, if that’s how their inflammation was sought, we would repeat an MRI to see if there’s still inflammation in that area. So all of those together to me would be basically endoscopic slash clinical remission. Now, when we do these, molonoscopies, endoscopies, we do take biopsies. So then that the next question is the biopsies; do those show active inflammation? Or quiescent inflammation? So then that’s a whole other kind of conversation that’s happening in the IBD world. Do we treat to target that the biopsies being essentially normal or showing quiescent or inactive disease? For me, if a patient’s endoscopic evaluation looks good, as well as their clinical symptoms, I would consider them to be in remission.
沈博博士:是的。我同意乔杜里博士的观点。就像他们，你发现病情缓解了，这应该是一个综合评估。我想说至少有两组标记，症状，还有内窥镜检查，可能还有一些实验室检查。我所做的一件事就是关于症状?症状，问题是它们不可靠。第一是客观的发现。例如，客观的内镜下的炎症反应，与患者的主观症状几乎完全不相关。你要做的另一件事是有一种经常使用的情况叫做去条件化。人们生病了很久，然后就习惯了，习惯了生病。 They may feel like this is the normal. So I’ll give you example. There’s a patient I saw and I say, David, how are you? How are you doing? I’m doing great. Okay. Let’s do colonoscopy. No symptoms. Then, when I took the colonoscopy, I found, you know what? T issue paper in between the buttock cheeks. I said, you said you don’t have symptoms. Yes. I don’t have symptoms. I said, how many people, like healthy people, put their tissue paper in between the buttock cheeks. I said, yeah, when you asked it because I leak all the time. Either leak since either diagnosed 10 years ago. Right? So you consider it as normal. As a matter of fact, it’s not normal. So that’s why the symptoms not totally accurate. And then of course if you use the endoscopy, it would be the cost, right? So that’s why you, the endoscopy we consider, if you measure remission by the expensive tool. Now, if the cheaper tool the people use the labs, right. Lab in general, labs include anemia, nutrition, like albumin, and then other inflammatory marker, like the CRP, sedimentation rate. So it’s a combination. Just the bottom line is that the symptoms alone is not enough.
