Triantafillidis J K, Emmanouilidis A, Manousos O, Nicolakis D, Kogevinas M
Departments of Gastroenterology, Saint Panteleimon General State Hospital, Nicea, Pireaus, Greece.
Digestion. 2000;61(2):121-8. doi: 10.1159/000007744.
The aim of this prospective study was to elucidate the clinical features and natural history of Crohn's disease in Greece. One hundred and fifty-five Greek patients with definite diagnosis of Crohn's disease were followed-up for a mean period of 9.7 years and evaluated for clinical patterns and course of illness. The male/female ratio was 1.58:1. The peak incidence of the disease was observed between 20 and 30 years of age. The majority of patients were urban dwellers and of higher socio-economic level compared to the general population of Greece. In almost 50% of the patients symptoms of the disease started below the age of 30, although in almost one in every 5 cases, symptoms appeared after the age of 50. Familial clustering of inflammatory bowel disease was observed in 1. 3%. The pattern of anatomic involvement was: ileocolic 33.3%, colon 33.3% and small bowel 33.3%. The kind of predominant symptoms at the time of diagnosis was related to the anatomic location of the disease. At least one extraintestinal manifestation appeared in 42% of patients. Perianal disease was noticed in 21.3% with fistulae and abscesses being the most common manifestation. Fifty-one percent of patients were operated upon at least once during the follow-up period because of acute abdomen, bad response to conservative treatment and fistulae and abscesses. Emergency operation was required in 17.3% of the patients. Evolution to cancer was observed in 3 patients (2%). During the follow-up period of 9.7 +/- 6.5 years, 18 patients (11.6%) died. A considerable mortality was noticed in the surgically treated group of patients, while in the nonoperated group the disease was running with milder symptoms. It is concluded that some of the clinicoepidemiological characteristics of patients with Crohn's disease in Greece are in accordance with those reported from western as well as the neighboring Mediterranean countries. However, other parameters such as the higher incidence of the disease in males, the low incidence of familial clustering, and the low incidence of perianal disease, underline the importance of environmental, genetic and other factors on the evolution and behavior of the disease in different parts of the world.
这项前瞻性研究的目的是阐明希腊克罗恩病的临床特征和自然病程。155例确诊为克罗恩病的希腊患者接受了平均9.7年的随访，并对其临床模式和病程进行了评估。男女比例为1.58:1。该病的发病高峰出现在20至30岁之间。与希腊普通人群相比，大多数患者是城市居民，社会经济水平较高。近50%的患者在30岁以下出现疾病症状，尽管每5例中几乎有1例症状出现在50岁以后。1.3%的患者观察到炎症性肠病的家族聚集现象。解剖受累模式为：回结肠33.3%，结肠33.3%，小肠33.3%。诊断时主要症状的类型与疾病的解剖位置有关。42%的患者至少出现一种肠外表现。21.3%的患者出现肛周疾病，瘘管和脓肿是最常见的表现。51%的患者在随访期间因急腹症、对保守治疗反应不佳以及瘘管和脓肿至少接受过一次手术。17.3%的患者需要急诊手术。3例患者（2%）发生癌变。在9.7±6.5年的随访期内，18例患者（11.6%）死亡。在接受手术治疗的患者组中观察到相当高的死亡率，而在未手术组中，疾病症状较轻。结论是，希腊克罗恩病患者的一些临床流行病学特征与西方以及邻近地中海国家报道的特征一致。然而，其他参数，如男性发病率较高、家族聚集发病率较低以及肛周疾病发病率较低，凸显了环境、遗传和其他因素对世界各地该疾病演变和行为的重要性。
