Department of Gastroenterology and Hepatology, Maastricht University Medical Center, the Netherlands.
Inflamm Bowel Dis. 2010 Aug;16(8):1397-410. doi: 10.1002/ibd.21189.
The aim was to evaluate overall and disease-specific mortality in a population-based inflammatory bowel disease (IBD) cohort in the Netherlands, as well as risk factors for mortality.
IBD patients diagnosed between 1 January 1991 and 1 January 2003 were included. Standardized mortality ratios (SMRs) were calculated overall and with regard to causes of death, gender, as well as age, phenotype, smoking status at diagnosis, and medication use.
At the censoring date, 72 out of 1187 patients had died (21 Crohn's disease [CD], 47 ulcerative colitis [UC], and 4 indeterminate colitis [IC] patients). The SMR (95% confidence interval [CI]) was 1.1 (0.7-1.6) for CD, 0.9 (0.7-1.2) for UC and 0.7 (0.2-1.7) for IC. Disease-specific mortality risk was significantly increased for gastrointestinal (GI) causes of death both in CD (SMR 7.5, 95% CI: 2.8-16.4) and UC (SMR 3.4, 95% CI: 1.4-7.0); in CD patients, especially in patients <40 years of age at diagnosis. For UC, an increased SMR was noted in female patients and in patients <19 years and >80 years at diagnosis. In contrast, UC patients had a decreased mortality risk from cancer (SMR 0.5, 95% CI; 0.2-0.9).
In this population-based IBD study, mortality in CD, UC, and IC was comparable to the background population. The increased mortality risk for GI causes might reflect complicated disease course, with young and elderly patients at diagnosis needing intensive follow-up. Caution in interpreting the finding on mortality risk from cancer is needed as follow-up was probably to short to observe IBD-related cancers.
本研究旨在评估荷兰基于人群的炎症性肠病（IBD）队列的总体和疾病特异性死亡率，以及死亡率的相关风险因素。
本研究纳入了 1991 年 1 月 1 日至 2003 年 1 月 1 日期间诊断为 IBD 的患者。计算了标准化死亡率比（SMR），并根据死因、性别以及年龄、表型、诊断时的吸烟状况和药物使用情况进行了分层。
截止到删失日期，1187 例患者中有 72 例死亡（21 例克罗恩病[CD]、47 例溃疡性结肠炎[UC]和 4 例未定型结肠炎[IC]）。CD、UC 和 IC 的 SMR（95%CI）分别为 1.1（0.7-1.6）、0.9（0.7-1.2）和 0.7（0.2-1.7）。CD 和 UC 的胃肠道（GI）死因特异性死亡率风险显著增加（SMR 分别为 7.5，95%CI：2.8-16.4 和 3.4，95%CI：1.4-7.0）；在 CD 患者中，特别是在诊断时年龄<40 岁的患者中，这一风险更为显著。对于 UC，在女性患者和诊断时年龄<19 岁和>80 岁的患者中，也观察到 SMR 增加。相反，UC 患者的癌症死亡率降低（SMR 0.5，95%CI；0.2-0.9）。
在这项基于人群的 IBD 研究中，CD、UC 和 IC 的死亡率与基础人群相当。GI 原因导致的死亡率增加可能反映了复杂的疾病过程，年轻和老年患者的诊断需要更密切的随访。在解释癌症死亡率风险的发现时需要谨慎，因为随访时间可能太短，无法观察到与 IBD 相关的癌症。
