Wolters F L, Russel M G, Sijbrandij J, Ambergen T, Odes S, Riis L, Langholz E, Politi P, Qasim A, Koutroubakis I, Tsianos E, Vermeire S, Freitas J, van Zeijl G, Hoie O, Bernklev T, Beltrami M, Rodriguez D, Stockbrügger R W, Moum B
Department of Gastroenterology and Hepatology, University Hospital Maastricht, the Netherlands.
Gut. 2006 Aug;55(8):1124-30. doi: 10.1136/gut.2005.084061. Epub 2005 Dec 16.
In Crohn's disease (CD), studies associating phenotype at diagnosis and subsequent disease activity are important for patient counselling and health care planning.
To calculate disease recurrence rates and to correlate these with phenotypic traits at diagnosis.
A prospectively assembled uniformly diagnosed European population based inception cohort of CD patients was classified according to the Vienna classification for disease phenotype at diagnosis. Surgical and non-surgical recurrence rates throughout a 10 year follow up period were calculated. Multivariate analysis was performed to classify risk factors present at diagnosis for recurrent disease.
A total of 358 were classified for phenotype at diagnosis, of whom 262 (73.2%) had a first recurrence and 113 patients (31.6%) a first surgical recurrence during the first 10 years after diagnosis. Patients with upper gastrointestinal disease at diagnosis had an excess risk of recurrence (hazard ratio 1.54 (95% confidence interval (CI) 1.13-2.10)) whereas age >/=40 years at diagnosis was protective (hazard ratio 0.82 (95% CI 0.70-0.97)). Colonic disease was a protective characteristic for resective surgery (hazard ratio 0.38 (95% CI 0.21-0.69)). More frequent resective surgical recurrences were reported from Copenhagen (hazard ratio 3.23 (95% CI 1.32-7.89)).
A mild course of disease in terms of disease recurrence was observed in this European cohort. Phenotype at diagnosis had predictive value for disease recurrence with upper gastrointestinal disease being the most important positive predictor. A phenotypic North-South gradient in CD may be present, illustrated by higher surgery risks in some of the Northern European centres.
在克罗恩病（CD）中，将诊断时的表型与随后的疾病活动相关联的研究对于患者咨询和医疗保健规划很重要。
计算疾病复发率，并将其与诊断时的表型特征相关联。
根据诊断时疾病表型的维也纳分类，对前瞻性收集的统一诊断的欧洲CD患者起始队列进行分类。计算整个10年随访期内的手术和非手术复发率。进行多变量分析以对诊断时存在的复发性疾病风险因素进行分类。
共有358例在诊断时进行了表型分类，其中262例（73.2%）在诊断后的前10年内首次复发，113例患者（31.6%）首次手术复发。诊断时患有上消化道疾病的患者复发风险更高（风险比1.54（95%置信区间（CI）1.13 - 2.10）），而诊断时年龄≥40岁具有保护作用（风险比0.82（95%CI 0.70 - 0.97））。结肠疾病是手术切除的保护特征（风险比0.38（95%CI 0.21 - 0.69））。哥本哈根报告的手术切除复发性疾病更为频繁（风险比3.23（95%CI 1.32 - 7.89））。
在这个欧洲队列中观察到疾病复发方面的疾病进程较为温和。诊断时的表型对疾病复发具有预测价值，上消化道疾病是最重要的阳性预测因素。CD可能存在表型的南北梯度差异，一些北欧中心的手术风险较高说明了这一点。
