山东医药

目的 探讨血清轴抑制因子1(AXIN1)、磺基转移酶1A1(ST1A1)与溃疡性结肠炎（UC）患者疾病活动度及复发风险的关系。方法 收集230例UC患者，并选取同期230例健康体检者作为对照人群。采用ELISA法检测血清AXIN1、ST1A1水平。根据Mayo评分将UC患者分为缓解期和活动期，活动期患者进一步分为轻度、中度和重度。UC患者治疗出院后随访6个月，根据随访期间是否复发分为复发患者与未复发患者。采用单因素和多因素Logistic回归分析UC患者复发的影响因素，受试者工作特征（ROC）曲线分析AXIN1、ST1A1预测UC患者复发的效能，临床决策曲线分析（DCA）评估预测模型的临床实用性。结果 UC患者血清AXIN1水平高于对照人群，ST1A1水平低于对照人群（P均<0.05）。处于缓解期患者113例，活动期患者117例，其中轻度38例、中度43例、重度36例。活动期患者血清AXIN1水平高于缓解期患者，ST1A1水平低于缓解期患者（P均<0.05）；且随着疾病活动程度加重，血清AXIN1水平逐渐升高，ST1A1水平逐渐降低（P均<0.05）。随访期间2例患者失访，92例患者复发，136例患者未复发。复发患者血清AXIN1水平高于未复发患者，ST1A1水平低于未复发患者（P均<0.05）。复发患者既往复发史、处于活动期、全结肠病变、随访期间感染比例及中性粒细胞计数、C反应蛋白、红细胞沉降率高于未复发患者（P均<0.05）。多因素Logistic回归分析结果显示，活动期、全结肠病变、随访期间感染、高AXIN1水平是UC患者复发的独立危险因素，高ST1A1水平则是独立保护因素（P均<0.05）。AXIN1、ST1A1联合预测UC患者复发的曲线下面积为0.892，高于二者单独预测的0.803、0.832(P均<0.05)。DCA结果显示，在10%～90%阈值概率内，联合模型预测UC患者复发具有较好的潜在临床净收益。结论 UC患者血清AXIN1水平升高、ST1A1水平降低与疾病活动度及复发风险升高有关，二者联合检测对UC患者复发风险的识别有一定临床应用价值。

Objective To investigate the relationships between serum levels of axis inhibition protein 1(AXIN1) and sulfotransferase 1A1(ST1A1) and disease activity and recurrence risk in patients with ulcerative colitis(UC).Methods A total of 230 patients with UC and 230 age-and sex-matched healthy individuals were enrolled as the control.Serum AXIN1 and ST1A1 levels were measured using ELISA.According to the Mayo score, UC patients were classified into the remission and active disease, and patients with active disease were further categorized into the mild, moderate, or severe disease.After treatment and discharge, all UC patients were followed up for 6 months and were classified into the recurrence and non-recurrence patients according to recurrence during follow-up.Univariate and multivariate Logistic regression analyses were performed to identify factors associated with recurrence.Receiver operating characteristic(ROC) curve analysis was used to evaluate the predictive performance of AXIN1 and ST1A1 for UC recurrence, and decision curve analysis(DCA) was conducted to assess the clinical utility of the prediction model.Results Serum AXIN1 level was significantly higher and ST1A1 level was significantly lower in patients with UC than in healthy controls(both P<0.05).Among the 230 UC patients, 113 were in remission and 117 had active disease, including 38 with mild, 43 with moderate, and 36 with severe disease.Patients with active disease had significantly higher serum AXIN1 levels and lower ST1A1 levels than those in remission(both P<0.05).Serum AXIN1 levels increased progressively, whereas ST1A1 levels decreased progressively with increasing disease activity(both P<0.05).During the follow-up, 2 patients were lost to follow-up, 92 experienced recurrence, and 136 remained recurrence-free.Patients with recurrence had significantly higher serum AXIN1 levels and lower ST1A1 levels than those without recurrence(both P<0.05).The recurrence patients also had higher proportions of previous recurrence, active disease, pancolitis, and infection during follow-up, as well as higher neutrophil counts, C-reactive protein(CRP), and erythrocyte sedimentation rate(ESR) levels than the non-recurrence patients(all P<0.05).Multivariate Logistic regression analysis identified active disease, pancolitis, infection during followup, and elevated serum AXIN1 as independent risk factors for recurrence, whereas elevated serum ST1A1 was an independent protective factor(all P<0.05).The area under the ROC curve(AUC) of the combined AXIN1-ST1A1 model for predicting UC recurrence was 0.892, which was significantly higher than that of AXIN1(0.803) or ST1A1(0.832) alone(both P<0.05).DCA demonstrated that the combined model provided favorable potential clinical net benefit across threshold probabilities ranging from 10% to 90%.Conclusions Elevated serum AXIN1 and reduced ST1A1 levels are associated with increased disease activity and recurrence risk in patients with UC.Combined assessment of these two biomarkers may provide clinical value for identifying patients at high risk of recurrence.