Economou Michael, Pappas Georgios
Institute of Continuing Medical Education of Ioannina, Greece.
Inflamm Bowel Dis. 2008 May;14(5):709-20. doi: 10.1002/ibd.20352.
Seventy-five years after the initial characterization of Crohn's disease (CD), much remains obscure about its etiology. The authors sought to evaluate the incidence trends of the last 25 years worldwide, and the existence of potential correlations with genetic, environmental, and socioeconomic factors that could be etiologically implicated in the pathogenesis of CD. Relevant medical literature for individual countries on the incidence of CD, on the incidence of associated genetic mutations, and on the incidence of suggested etiologic infectious agents such as Mycobacterium avium paratuberculosis were retrieved from published medical literature, reports from relevant international congresses, and through official reports from national health authorities. Increasing trends have been observed almost worldwide, with a broad north-south gradient still prevailing in Europe. Distinct regions of New Zealand, Canada, Scotland, France, the Netherlands, and Scandinavia represent the highest incidence areas. Industrialized status and affluence are the common denominators between endemic areas, but are too broad as terms to strongly indicate any particular etiological role. The increasing trends observed in Asia still account for a low prevalence of the disease and may represent increased detection and diagnostic ability of local health systems. Genetic associations are variably reproduced worldwide, in a manner inconsistent with a strong etiologic relationship. Data on paratuberculosis incidence are scarce, and the existing ones are ambivalent regarding an even indirect correlation between CD and an infectious trigger.
在克罗恩病（CD）首次被描述75年后，其病因仍有许多不明之处。作者试图评估过去25年全球范围内CD的发病率趋势，以及与可能在CD发病机制中具有病因学关联的遗传、环境和社会经济因素之间是否存在潜在相关性。从已发表的医学文献、相关国际会议报告以及国家卫生当局的官方报告中检索了各个国家关于CD发病率、相关基因突变发生率以及诸如副结核分枝杆菌等提示性病因感染因子发生率的相关医学文献。几乎在全球范围内都观察到了上升趋势，欧洲仍普遍存在明显的南北梯度差异。新西兰、加拿大、苏格兰、法国、荷兰和斯堪的纳维亚半岛的不同地区是发病率最高的地区。工业化状态和富裕程度是这些流行地区的共同特征，但作为术语过于宽泛，难以有力地表明任何特定的病因学作用。在亚洲观察到的上升趋势中，该病的患病率仍然较低，这可能代表当地卫生系统检测和诊断能力的提高。遗传关联在全球范围内的再现情况各不相同，其方式与强烈的病因学关系不一致。关于副结核发病率的数据稀缺，现有数据对于CD与感染触发因素之间即使是间接关联也存在矛盾之处。
