克罗恩病家族史与储袋型克罗恩病风险增加相关。
Family history of Crohn's disease is associated with an increased risk for Crohn's disease of the pouch.
作者信息
Shen Bo, Remzi Feza H, Hammel Jeffrey P, Lashner Bret A, Bevins Charles L, Lavery Ian C, Wehkamp Jan, Fazio Victor W
机构信息
Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
出版信息
Inflamm Bowel Dis. 2009 Feb;15(2):163-70. doi: 10.1002/ibd.20646.
BACKGROUND
Crohn's disease (CD) of the pouch can occur in patients with restorative proctocolectomy and ileal pouch-anal anastomosis originally performed for a preoperative diagnosis of ulcerative colitis (UC). CD of the pouch was often observed in patients with a family history of CD. The purpose was to determine whether the family history of CD increased the risk for CD of the pouch in patients who underwent restorative proctocolectomy.
METHODS
A total of 558 eligible patients seen in the Pouchitis Clinic were enrolled, including 116 patients with CD of the pouch and 442 patients with a normal pouch or other pouch disorders. Demographic and clinical variables were included in the study. Multivariable logistic regression analyses were performed.
RESULTS
The adjusted multivariate logistic analyses revealed that the risk for CD of the pouch was increased in patients with a family history of CD, with an odds ratio (OR) of 3.22 (95% confidence interval [CI] 1.56-6.67), or with a first-degree relative with CD (OR = 4.18, 95% CI, 1.48-11.8), or with a greater number of family members with CD (OR = 2.00 per family member, 95% CI, 1.19-3.37), adjusting for age, gender, smoking status, duration of IBD, duration of having a pouch, and a preoperation diagnosis of indeterminate colitis or CD. In addition, patients of younger age and longer duration of having a pouch had a higher risk for CD of the pouch. A diagnosis of CD of the pouch was associated with a poor outcome, with a greater than 5-fold estimated increased odds of pouch failure (OR = 5.58, 95% CI, 2.74-11.4).
CONCLUSIONS
The presence of a family history of CD is associated with an increased risk for CD of the pouch, which in turn has a high risk for pouch failure.
背景
在最初因术前诊断为溃疡性结肠炎（UC）而接受结直肠切除加回肠储袋肛管吻合术的患者中，可能会发生储袋克罗恩病（CD）。储袋CD在有CD家族史的患者中经常被观察到。目的是确定CD家族史是否会增加接受结直肠切除的患者发生储袋CD的风险。
方法
共纳入558例在储袋炎诊所就诊的符合条件的患者，其中116例患有储袋CD，442例储袋正常或有其他储袋疾病。研究纳入了人口统计学和临床变量。进行了多变量逻辑回归分析。
结果
调整后的多变量逻辑分析显示，有CD家族史的患者发生储袋CD的风险增加，比值比（OR）为3.22（95%置信区间[CI]1.56 - 6.67），或有患CD的一级亲属（OR = 4.18，95% CI，1.48 - 11.8），或有更多患CD的家庭成员（每增加一名家庭成员OR = 2.00，95% CI，1.19 - 3.37），在对年龄、性别、吸烟状况、炎症性肠病（IBD）病程、有储袋的时间以及术前不确定结肠炎或CD的诊断进行校正后。此外，年龄较小和有储袋时间较长的患者发生储袋CD的风险较高。储袋CD的诊断与不良结局相关，估计储袋失败的几率增加超过5倍（OR = 5.58，95% CI，2.74 - 11.4）。
结论
CD家族史与储袋CD风险增加相关，而储袋CD反过来又有较高的储袋失败风险。
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