Deveaux Peter G, Kimberling Jennifer, Galandiuk Susan
Department of Surgery, University of Louisville School of Medicine, Louisville, Kentucky, USA.
Dis Colon Rectum. 2005 Jul;48(7):1404-9. doi: 10.1007/s10350-005-0034-8.
Common belief based on clinical experience suggests that Crohn's disease is more severe among black patients, although little data exists on the effect of race on Crohn's disease. We compared multiple variables among black patients with Crohn's disease requiring surgery to those of white patients presenting to a university colorectal surgery unit during a five-year period.
A total of 345 patients required surgery for Crohn's disease between June 1998 and September 2003. The following data were abstracted from patient charts and a prospectively maintained database: age at diagnosis; age at first Crohn's disease surgery; presenting symptoms; incidence, number and location of fistulas at presentation; number of Crohn's disease operations; and family history of inflammatory bowel disease. Data regarding medical insurance coverage also were obtained. Complete data were evaluable on 178 patients. Patient variables were analyzed using the chi-squared, Fisher exact, and Student t-tests.
Mean age at diagnosis was 28 years for white males, 20 years for black males, 30 years for white females, and 28 years for black females (all p > 0.05). Thirty-seven percent of white females presented with obstructive symptoms vs. 12 percent of black females. (P = 0.011). Sixty-five percent of black females presented with inflammatory symptoms compared with 28 percent of white females (P = 0.001). Of females presenting with fistulas, 15 percent of black patients had a rectovaginal fistula compared with 5 percent of white patients. Seventeen percent of black males and 21 percent of white males had intra-abdominal fistulas. None of these differences were statistically significant. The incidence of fistulas at presentation, mean number of fistulas, total number of operations, and family history of inflammatory bowel disease did not differ.
Contrary to expectations, Crohn's disease does not seem to be more severe among black patients, who had an earlier age of diagnosis, although this was not statistically significant. Overall, there was no difference in disease presentation. White females were more likely to present with obstructive symptoms compared with black females, who more often presented with inflammatory symptoms. Among patients with fistulas, the incidence of rectovaginal fistulas was higher in black females compared with white females, and white males were somewhat more likely to have intra-abdominal fistulas than black males. Although there was no demonstrated difference in incidence and mean number of fistulas at presentation, the number of operations for Crohn's disease, or family history of inflammatory bowel disease among blacks and whites, there are differences in presenting symptoms among these populations.
基于临床经验的普遍看法认为，克罗恩病在黑人患者中更为严重，尽管关于种族对克罗恩病影响的数据很少。我们比较了在五年期间因克罗恩病需要手术的黑人患者与到大学结直肠外科就诊的白人患者的多个变量。
1998年6月至2003年9月期间，共有345例患者因克罗恩病需要手术。从患者病历和前瞻性维护的数据库中提取了以下数据：诊断时的年龄；首次因克罗恩病手术时的年龄；出现的症状；就诊时瘘管的发生率、数量和位置；克罗恩病手术的次数；以及炎症性肠病的家族史。还获得了有关医疗保险覆盖范围的数据。178例患者的完整数据可供评估。使用卡方检验、Fisher精确检验和Student t检验分析患者变量。
白人男性诊断时的平均年龄为28岁，黑人男性为20岁，白人女性为30岁，黑人女性为28岁（所有p>0.05）。37%的白人女性表现为梗阻性症状，而黑人女性为12%（P = 0.011）。65%的黑人女性表现为炎症性症状，而白人女性为28%（P = 0.001）。在出现瘘管的女性中，15%的黑人患者有直肠阴道瘘，而白人患者为5%。17%的黑人男性和21%的白人男性有腹腔内瘘。这些差异均无统计学意义。就诊时瘘管的发生率、平均瘘管数量、手术总数以及炎症性肠病的家族史并无差异。
与预期相反，克罗恩病在黑人患者中似乎并不更严重，黑人患者的诊断年龄较早，尽管这在统计学上并不显著。总体而言，疾病表现没有差异。与黑人女性相比，白人女性更有可能表现为梗阻性症状，而黑人女性更常表现为炎症性症状。在有瘘管的患者中，黑人女性直肠阴道瘘的发生率高于白人女性，白人男性腹腔内瘘的可能性略高于黑人男性。尽管在就诊时瘘管的发生率和平均数量、克罗恩病手术的次数或黑人和白人炎症性肠病的家族史上没有显示出差异，但这些人群在出现的症状方面存在差异。
