Ishibashi N, Hirota Y, Ikeda M, Hirohata T
Department of Public Health, School of Medicine, Kyushu University, Fukuoka, Japan.
Int J Epidemiol. 1999 Aug;28(4):609-13. doi: 10.1093/ije/28.4.609.
Our goal was to study the higher death rate and the causes of such deaths among ulcerative colitis (UC) patients in the Japanese population, and to compare our findings in such cases with those for Crohn's disease (CD).
In all, 174 UC (male/female: 54/120) and 66 CD (34/32) patients who were registered for the research promotion programme in Fukuoka prefecture (1971-1981) were traced up to the end of 1994. The standardized mortality ratios (SMR) were calculated based on the death rates of the Japanese population by age, sex and calendar year.
The overall follow-up rate was 96.7%. Among the UC patients, the SMR for all causes were 0.84 (95% CI: 0.11-4.31) for men; 1.05 (95% CI: 0.08-4.69) for women; and 0.94 (95% CI :0.09-4.50) for both sexes combined. When excluding deaths due to colorectal cancer, the SMR for the same groups were 0.43, 0.94 and 0.67, respectively. The SMR for both sexes were 1.82 (95% CI: 0.17-5.96) for malignant neoplasms and 9.93 (95% CI: 4.67-17.3) for colorectal cancer. Patients who died from colorectal cancer showed onset at a younger age (mean: 25.5 years) as well as a longer disease course of UC (mean: 17.0 years). Regarding the CD patients, the SMR for all causes were 1.75 (95% CI: 0.15-5.75) for both sexes. Most deaths were caused by gastrointestinal complications.
An excess mortality from colorectal cancers was indicated in the UC patients, especially in males. The overall SMR in male UC patients decreased by 50% when the deaths from colorectal cancer were excluded. The excess mortality in those with CD over UC patients was attributed to gastrointestinal complications rather than malignant diseases. Some carcinogenic factors therefore seem most likely to exist in the pathogenesis of UC.
我们的目标是研究日本人群中溃疡性结肠炎（UC）患者较高的死亡率及其死亡原因，并将此类病例的研究结果与克罗恩病（CD）患者的结果进行比较。
对福冈县（1971 - 1981年）注册参加研究促进项目的174例UC患者（男/女：54/120）和66例CD患者（34/32）进行追踪，直至1994年底。根据日本人群按年龄、性别和历年的死亡率计算标准化死亡比（SMR）。
总体随访率为96.7%。在UC患者中，男性所有原因的SMR为0.84（95%可信区间：0.11 - 4.31）；女性为1.05（95%可信区间：0.08 - 4.69）；男女合计为0.94（95%可信区间：0.09 - 4.50）。排除结直肠癌导致的死亡后，同组的SMR分别为0.43、0.94和0.67。男女恶性肿瘤的SMR为1.82（95%可信区间：0.17 - 5.96），结直肠癌的SMR为9.93（95%可信区间：4.67 - 17.3）。死于结直肠癌的患者发病年龄较轻（平均：25.5岁），UC病程较长（平均：17.0年）。对于CD患者，男女所有原因的SMR为1.75（95%可信区间：0.15 - 5.75）。大多数死亡由胃肠道并发症引起。
UC患者中结直肠癌导致的死亡率过高，尤其是男性。排除结直肠癌导致的死亡后，男性UC患者的总体SMR降低了50%。CD患者相对于UC患者的过高死亡率归因于胃肠道并发症而非恶性疾病。因此，一些致癌因素似乎最有可能存在于UC的发病机制中。
