Lakatos Peter Laszlo, Czegledi Zsofia, Szamosi Tamas, Banai Janos, David Gyula, Zsigmond Ferenc, Pandur Tunde, Erdelyi Zsuzsanna, Gemela Orsolya, Papp Janos, Lakatos Laszlo
1st Department of Medicine, Semmelweis University, Koranyi str. 2/A, H-1083 Budapest, Hungary.
World J Gastroenterol. 2009 Jul 28;15(28):3504-10. doi: 10.3748/wjg.15.3504.
To assess the combined effect of disease phenotype, smoking and medical therapy [steroid, azathioprine (AZA), AZA/biological therapy] on the probability of disease behavior change in a Caucasian cohort of patients with Crohn's disease (CD).
Three hundred and forty well-characterized, unrelated, consecutive CD patients were analyzed (M/F: 155/185, duration: 9.4 +/- 7.5 years) with a complete clinical follow-up. Medical records including disease phenotype according to the Montreal classification, extraintestinal manifestations, use of medications and surgical events were analyzed retrospectively. Patients were interviewed on their smoking habits at the time of diagnosis and during the regular follow-up visits.
A change in disease behavior was observed in 30.8% of patients with an initially non-stricturing, non-penetrating disease behavior after a mean disease duration of 9.0 +/- 7.2 years. In a logistic regression analysis corrected for disease duration, perianal disease, smoking, steroid use, early AZA or AZA/biological therapy use were independent predictors of disease behavior change. In a subsequent Kaplan-Meier survival analysis and a proportional Cox regression analysis, disease location (P = 0.001), presence of perianal disease (P < 0.001), prior steroid use (P = 0.006), early AZA (P = 0.005) or AZA/biological therapy (P = 0.002), or smoking (P = 0.032) were independent predictors of disease behavior change.
Our data suggest that perianal disease, small bowel disease, smoking, prior steroid use, early AZA or AZA/biological therapy are all predictors of disease behavior change in CD patients.
评估疾病表型、吸烟及药物治疗[类固醇、硫唑嘌呤（AZA）、AZA/生物治疗]对一组白种人克罗恩病（CD）患者疾病行为改变可能性的联合影响。
对340例特征明确、无亲缘关系、连续入选的CD患者（男/女：155/185，病程：9.4±7.5年）进行分析，这些患者均有完整的临床随访资料。回顾性分析病历，包括根据蒙特利尔分类法的疾病表型、肠外表现、用药情况及手术事件。在诊断时及定期随访时询问患者的吸烟习惯。
在平均病程9.0±7.2年后，30.8%最初表现为非狭窄、非穿透性疾病行为的患者出现了疾病行为改变。在对病程、肛周疾病、吸烟、类固醇使用、早期使用AZA或AZA/生物治疗进行校正的逻辑回归分析中，这些因素是疾病行为改变的独立预测因素。在随后的Kaplan-Meier生存分析和比例Cox回归分析中，疾病部位（P = 0.001）、肛周疾病的存在（P < 0.001）、既往类固醇使用（P = 0.006）、早期使用AZA（P = 0.005）或AZA/生物治疗（P = 0.002）以及吸烟（P = 0.032）均为疾病行为改变的独立预测因素。
我们的数据表明，肛周疾病、小肠疾病、吸烟、既往类固醇使用、早期使用AZA或AZA/生物治疗均是CD患者疾病行为改变的预测因素。
