Garrido A, Martínez M J, Ortega J A, Lobato A, Rodríguez M J, Guerrero F J
Department of Gastrointestinal Medicine, Hospital Comarcal de Riotinto, Huelva, Spain.
Rev Esp Enferm Dig. 2004 Oct;96(10):687-91; 691-4. doi: 10.4321/s1130-01082004001000003.
To know the different epidemiologic aspects of chronic inflammatory bowel disease (IBD) in the Northern area of the province of Huelva.
we carried out a retrospective (1980-1996) and prospective (1996-2003) study of all patients diagnosed with IBD in the Northern area of Huelva, with 77,856 inhabitants. The distribution of Crohn s disease (CD) and ulcerative colitis (UC) was analyzed, as well as sex, age and smoking habit at the time of diagnosis, familial aggregation, appendicectomy rate, phenotype (anatomical site and clinical types), extraintestinal manifestations, and immunosuppressive therapy or surgical requirements.
70 patients with IBD were studied, 40 with UC and 30 with CD. Sex distribution was 39 (55.7%) males (55% with CD vs 56.6% with UC; NS) and 31 (44.3%) females (45% with CD vs 43.3% with UC; NS). Mean age at presentation was 44.7 +/- 19.32 years in UC vs 32.3 +/- 16.43 in CD; p < 0.001. Familial association was 7.1%. Previous appendicectomy was referred in 2.5% of patients with UC vs 36.7% of those with CD (p < 0.001), and the percentage of smokers was also higher in CD 66.7% vs CU 12.5% (p < 0.001). Anatomical site in UC was: proctitis, 20%; proctosigmoiditis/left colon, 42.5%; extensive colitis, 25%; and pancolitis, 12.5%; in CD was: terminal ileum, 43.3%; colon, 20%; and ileo-colon, 36.7%. The disease patterns were: inflammatory 56.7%, obstruction 26.7%, and fistulization 16.7%. Extraintestinal manifestations were diagnosed in 7.5% of patients with UC vs 16.6% patients with CD; surgery was performed in one patient with UC vs 10 with CD, and one patient with UC required immunosuppressive treatment vs 12 with CD. A multivariant analysis showed that younger age and smoking habit were risk factors for CD vs advanced age in UC, in which case, the smoking habit was a protective factor. The mean incidence rate of IBD starting from 1996 and expressed in cases/100,000 inhabitants/year was 5.2 for UC and 6.6 for CD.
The mean incidence of UC in our area was 5.2 cases/100,000/inhabitants/year, and 6.6 for CD. Patients presenting with CD are diagnosed at a significantly younger age that those with UC; the smoking habit is a risk factor for CD while it protects from UC. The characteristics of IBD in our geographical area do not differ substantially from those in other regions of Spain.
了解韦尔瓦省北部地区慢性炎症性肠病（IBD）的不同流行病学特征。
我们对韦尔瓦省北部地区所有诊断为IBD的患者进行了回顾性研究（1980 - 1996年）和前瞻性研究（1996 - 2003年），该地区有77,856名居民。分析了克罗恩病（CD）和溃疡性结肠炎（UC）的分布情况，以及诊断时的性别、年龄、吸烟习惯、家族聚集性、阑尾切除术率、表型（解剖部位和临床类型）、肠外表现，以及免疫抑制治疗或手术需求。
共研究了70例IBD患者，其中40例为UC，30例为CD。性别分布为男性39例（55.7%）（CD患者中男性占55%，UC患者中男性占56.6%；无显著差异），女性31例（44.3%）（CD患者中女性占45%，UC患者中女性占43.3%；无显著差异）。UC患者发病时的平均年龄为44.7±19.32岁，CD患者为32.3±16.43岁；p<0.001。家族关联率为7.1%。2.5%的UC患者有阑尾切除术史，而CD患者中这一比例为36.7%（p<0.001），CD患者中的吸烟者比例也更高，为66.7%，而UC患者中为12.5%（p<0.001）。UC的解剖部位分布为：直肠炎20%；直肠乙状结肠炎/左半结肠42.5%；广泛结肠炎25%；全结肠炎12.5%；CD的解剖部位分布为：回肠末端43.3%；结肠20%；回结肠36.7%。疾病模式为：炎症型56.7%，梗阻型26.7%，瘘管型16.7%。7.5%的UC患者诊断有肠外表现，而CD患者中这一比例为16.6%；1例UC患者接受了手术，10例CD患者接受了手术，1例UC患者需要免疫抑制治疗，12例CD患者需要免疫抑制治疗。多变量分析显示，年龄较小和吸烟习惯是CD的危险因素，而在UC中高龄是危险因素，在这种情况下，吸烟习惯是一个保护因素。从1996年开始，以病例数/10万居民/年表示的IBD平均发病率，UC为5.2，CD为6.6。
我们地区UC的平均发病率为5.2例/10万居民/年，CD为6.6例/10万居民/年。CD患者的诊断年龄明显低于UC患者；吸烟习惯是CD的危险因素，而对UC有保护作用。我们地理区域内IBD的特征与西班牙其他地区没有实质性差异。
