Etienney Isabelle, Bouhnik Yoram, Gendre Jean-Pierre, Lémann Marc, Cosnes Jacques, Matuchansky Claude, Beaugerie Laurent, Modigliani Robert, Rambaud Jean-Claude
Hépato-Gastroentérologie et Assistance Nutritive, Hôpital Lariboisière, Paris.
Gastroenterol Clin Biol. 2004 Dec;28(12):1233-9. doi: 10.1016/s0399-8320(04)95216-5.
Patients frequently ask questions about the lifetime prognosis of Crohn's disease. The aim of this study was to describe the outcomes of Crohn's disease more than 20 years after diagnosis.
Data from all patients with Crohn's disease whose diagnosis had been performed before 1st January 1978 were analyzed. All referred patients filled in a medical and health-related quality-of-life questionnaire.
Among 273 patients with Crohn's disease diagnosed more than 20 years ago, 141 (52%) patients answered our questionnaire, 45 (16%) patients were alive but did not wish to answer our questionnaire, 51 (19%) could not be traced and 36 (13%) died before July 1998. At the end of follow-up, 25.7 (20.0-59.3) years after diagnosis, 24% had a relapse in the previous 12 months, and 48% and 28% had quiescent disease with and without treatment, respectively. These ratios were not different from those observed three years after Crohn's disease diagnosis. Sixteen patients died within 20 years after CD diagnosis, including 11 from CD-related causes. The risk of death estimated by Kaplan-Meier life-tables analysis was non-significantly higher if death was related to CD. An ileal or colic adenocarcinoma was noted in 6 (3.4%) patients.
Crohn's disease activity does not burn out with time, and roughly one-quarter of the patients had active disease 20 years after diagnosis.
患者经常询问有关克罗恩病终身预后的问题。本研究的目的是描述克罗恩病确诊20多年后的预后情况。
对1978年1月1日前确诊的所有克罗恩病患者的数据进行分析。所有转诊患者均填写了一份与医疗和健康相关的生活质量问卷。
在20多年前确诊的273例克罗恩病患者中，141例（52%）患者回答了我们的问卷，45例（16%）患者存活但不愿回答我们的问卷，51例（19%）无法联系到，36例（13%）在1998年7月前死亡。随访结束时，确诊后25.7（20.0 - 59.3）年，24%的患者在过去12个月内复发，48%和28%的患者分别在接受和未接受治疗的情况下病情处于缓解期。这些比例与克罗恩病确诊三年后观察到的比例没有差异。16例患者在克罗恩病确诊后20年内死亡，其中11例死于与克罗恩病相关的原因。通过Kaplan-Meier生存表分析估计的死亡风险，如果死亡与克罗恩病相关则无显著升高。6例（3.4%）患者发现有回肠或结肠癌。
克罗恩病的活动不会随时间而消失，大约四分之一的患者在确诊20年后仍有活动性疾病。
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