Halfvarson Jonas, Jess Tine, Bodin Lennart, Järnerot Gunnar, Munkholm Pia, Binder Vibeke, Tysk Curt
Department of Internal Medicine, Orebro University Hospital, Orebro, Sweden.
Inflamm Bowel Dis. 2007 Dec;13(12):1536-44. doi: 10.1002/ibd.20242.
The genetic influence on disease course in inflammatory bowel disease (IBD) remains unknown. We therefore aimed to study longitudinal concordance for clinical characteristics and longitudinal stability using the Montreal Classification in an IBD twin population.
A total of 158 twins with ulcerative colitis (UC) (18 belonging to 9 concordant monozygotic pairs) and 141 twins with Crohn's disease (CD) (34 belonging to 17 concordant monozygotic pairs) were enrolled. Medical notes were scrutinized for clinical characteristics at diagnosis and after 10 years. Using the binominal distribution, we tested the hypothesis that clinical characteristics were independent within individuals in disease concordant monozygotic pairs.
In CD, location was identical in 11/17 monozygotic concordant pairs at diagnosis (P = 0.008) and in 11/16 pairs after 10 years (P = 0.02). Behavior at diagnosis was identical in 13/17 pairs (P = 0.03) and in 11/16 pairs after 10 years (P = 0.01). Monozygotic UC twins were concordant (within 5 years) for age at diagnosis (6/9 pairs; P < 0.001) and symptomatic onset (4/9 pairs; P = 0.02) but not for extent of disease at diagnosis or after 10 years. The Montreal Classification did not demonstrate longitudinal stability, either regarding location or behavior of CD or extent of UC.
The high phenotypic concordance, both at diagnosis and longitudinally, in monozygotic twins with CD supports a genetic influence not only on disease occurrence but also on disease course. This contrasts with UC, where the genetic impact appears less. Montreal Classification characteristics changed over time and should be used cautiously.
遗传因素对炎症性肠病（IBD）病程的影响尚不清楚。因此，我们旨在利用蒙特利尔分类法，对IBD双胞胎群体的临床特征纵向一致性和纵向稳定性进行研究。
共纳入158例溃疡性结肠炎（UC）双胞胎（18例属于9对同卵双生子一致性对）和141例克罗恩病（CD）双胞胎（34例属于17对同卵双生子一致性对）。仔细查阅病历，了解诊断时和10年后的临床特征。我们使用二项分布检验了疾病一致性同卵双生子对个体内临床特征独立的假设。
在CD中，11/17对同卵双生子在诊断时病变部位相同（P = 0.008），10年后11/16对相同（P = 0.02）。诊断时行为相同的有13/17对（P = 0.03），10年后11/16对相同（P = 0.01）。同卵双生子UC双胞胎在诊断年龄（6/9对；P < 0.001）和症状发作时间（4/9对；P = 0.02）上（5年内）一致，但在诊断时或10年后的疾病范围上不一致。蒙特利尔分类法在CD的病变部位或行为以及UC的范围方面均未显示出纵向稳定性。
同卵双生子CD患者在诊断时和纵向均具有较高的表型一致性，这支持了遗传因素不仅影响疾病发生，还影响疾病病程的观点。这与UC形成对比，UC中遗传影响似乎较小。蒙特利尔分类法的特征随时间变化，应谨慎使用。
