Jess Tine, Gamborg Michael, Munkholm Pia, Sørensen Thorkild I A
Department of Medical Gastroenterology C, Herlev University Hospital, Copenhagen, Denmark.
Am J Gastroenterol. 2007 Mar;102(3):609-17. doi: 10.1111/j.1572-0241.2006.01000.x.
It remains debated whether patients with ulcerative colitis (UC) are at greater risk of dying and whether a possible alteration in mortality can be attributed to specific causes of death. We aimed to clarify this issue by conducting a meta-analysis of population-based inception cohort studies on overall and cause-specific mortality in patients with UC.
The MEDLINE search engine and abstracts from international conferences were searched for relevant literature by use of explicit search criteria. STATA meta-analysis software was used to calculate pooled risk estimates (SMR, standardized mortality ratio, observed/expected deaths) of overall mortality and specific causes of death and to conduct metaregression analyses of the influence of specific variables on SMR.
Ten papers fulfilled the inclusion criteria, reporting SMRs varying from 0.7 to 1.4. The overall pooled estimate was 1.1 (95% confidence interval [CI] 0.9-1.2, P= 0.42). However, greater risk of dying was observed during the first years of follow-up, in patients with extensive colitis, and in patients from Scandinavia. Metaregression analysis showed an increase in SMR by increasing cohort size. UC-related mortality accounted for 17% of all deaths. Mortality from gastrointestinal diseases, nonalcoholic liver diseases, pulmonary embolisms, and respiratory diseases was increased whereas mortality from pulmonary cancer was reduced.
The overall risk of dying in patients with UC did not differ from that of the background population, although subgroups of patients were at greater risk of dying. The cause-of-death distribution seemed to differ from that of the background population.
溃疡性结肠炎（UC）患者的死亡风险是否更高，以及死亡率的可能变化是否可归因于特定死因，目前仍存在争议。我们旨在通过对基于人群的起始队列研究进行荟萃分析，以阐明UC患者的总体和特定死因死亡率问题。
使用明确的检索标准，在MEDLINE搜索引擎和国际会议摘要中检索相关文献。使用STATA荟萃分析软件计算总体死亡率和特定死因的合并风险估计值（标准化死亡比，SMR，观察到的/预期的死亡数），并对特定变量对SMR的影响进行元回归分析。
十篇论文符合纳入标准，报告的SMR在0.7至1.4之间。总体合并估计值为1.1（95%置信区间[CI]0.9 - 1.2，P = 0.42）。然而，在随访的最初几年、广泛性结肠炎患者以及来自斯堪的纳维亚半岛的患者中，观察到更高的死亡风险。元回归分析显示，随着队列规模的增加，SMR升高。UC相关死亡率占所有死亡的17%。胃肠道疾病、非酒精性肝病、肺栓塞和呼吸系统疾病的死亡率增加，而肺癌死亡率降低。
UC患者的总体死亡风险与背景人群无异，尽管部分亚组患者的死亡风险更高。死因分布似乎与背景人群不同。
