Loly Catherine, Belaiche Jacques, Louis Edouard
Department of Gastroenterology, CHU of Liège, GIGA Research University of Liège, Belgium.
Scand J Gastroenterol. 2008 Aug;43(8):948-54. doi: 10.1080/00365520801957149.
A model based on clinical characteristics at diagnosis and predicting the early development of disabling Crohn's disease (CD) has recently been proposed in order to target patients for early intervention. The objectives of this study were to confirm the predictive factors established in a previous study and to establish the predictive factors for the development of severe disease characterized by the development of clinically significant non-reversible damage.
Our retrospective study comprised a total of 361 patients with CD from our clinical database with a follow-up of longer than 5 years. Clinical, demographic and biological factors associated with the development of disabling disease (according to predefined criteria) within 5 years after the diagnosis of CD and with the time to development of severe disease (according to predefined criteria) were successively studied by univariate and multivariate analyses.
The rate of disabling CD within 5 years after diagnosis was 57.9%. Perianal lesions, the need for steroids to treat the first flare and ileo-colonic location, but not age below 40 years were confirmed as predictive markers. The rate of severe disease was 37.4%. Stricturing behaviour (HR: 2.11 (95% CI: 1.39-3.20)) and loss of weight (> 5 kg) (HR: 1.67 (95% CI: 1.14-2.45)) at diagnosis were independently associated with the time to development of severe disease. The predictive performances of the models generated were low.
Disabling and severe CD developed in roughly one-third and two-thirds of our patients, respectively. Some clinical predictive markers could be found or even confirmed but their performances were low.
最近提出了一种基于诊断时临床特征并预测致残性克罗恩病（CD）早期发展的模型，以便针对患者进行早期干预。本研究的目的是确认先前研究中确定的预测因素，并确定以临床上显著的不可逆损伤发展为特征的严重疾病发展的预测因素。
我们的回顾性研究共纳入了来自临床数据库的361例CD患者，随访时间超过5年。通过单因素和多因素分析，依次研究了与CD诊断后5年内致残性疾病（根据预定义标准）发展以及严重疾病发展时间（根据预定义标准）相关的临床、人口统计学和生物学因素。
诊断后5年内致残性CD的发生率为57.9%。肛周病变、首次发作时需要使用类固醇治疗以及回结肠部位，但40岁以下年龄不是预测指标，这些均被确认为预测标志物。严重疾病的发生率为37.4%。诊断时的狭窄行为（HR：2.11（95%CI：1.39 - 3.20））和体重减轻（>5kg）（HR：1.67（95%CI：1.14 - 2.45））与严重疾病发展时间独立相关。所生成模型的预测性能较低。
在我们的患者中，分别约有三分之一和三分之二发生了致残性和严重CD。可以找到甚至确认一些临床预测标志物，但其性能较低。
