Division of Surgery, Oncology, Reproductive Biology, and Anaesthetics, Imperial College London, London, United Kingdom.
Dis Colon Rectum. 2010 Feb;53(2):177-85. doi: 10.1007/DCR.0b013e3181b7bfb0.
This study used meta-analytical techniques to compare the recurrence of granulomatous vs nongranulomatous Crohn disease.
Comparative studies published between 1954 and 2007 of granulomatous vs nongranulomatous Crohn disease were included. Using a random effects model, end points evaluated were the number of recurrences and reoperations, and the time to recurrence and reoperation, of granulomatous vs nongranulomatous Crohn disease. Heterogeneity was assessed and sensitivity analysis was performed to account for bias in patient selection.
Twenty-one studies (14 nonrandomized retrospective, 7 nonrandomized prospective) reported on 2236 patients with Crohn disease, of whom 1050 (47.0%) had granulomas (granulomatous group) and 1186 (53.0%) had no granulomas (nongranulomatous group). The number of recurrences and reoperations was found to be significantly higher in the granulomatous group compared to the nongranulomatous group (odds ratio 1.37, P = .04; odds ratio 2.38, P < .001; respectively), with significant heterogeneity between studies (P = .06; P < .001; respectively). The time to recurrence and reoperation was significantly shorter in the granulomatous group compared with the nongranulomatous group (hazard ratio 1.63, P = .001; hazard ratio 1.62, P = .002; respectively), with no significant heterogeneity between studies. The number of recurrences and reoperations remained significantly higher in the granulomatous group compared to the nongranulomatous group during sensitivity analysis of higher-quality studies, more recent studies, and studies with a larger group of patients.
Granulomatous Crohn disease appears to be associated with a higher number of recurrences and reoperations and a shorter time to recurrence and reoperation compared to nongranulomatous Crohn disease. Because of significant heterogeneity between studies, further studies should be undertaken to confirm these findings.
本研究采用荟萃分析技术比较肉芽肿性与非肉芽肿性克罗恩病的复发情况。
纳入了 1954 年至 2007 年间发表的比较肉芽肿性与非肉芽肿性克罗恩病的对照研究。采用随机效应模型，评估的终点为肉芽肿性与非肉芽肿性克罗恩病的复发和再手术次数，以及复发和再手术的时间。评估了异质性，并进行敏感性分析以纠正患者选择偏倚。
21 项研究（14 项非随机回顾性研究，7 项非随机前瞻性研究）报告了 2236 例克罗恩病患者的资料，其中 1050 例（47.0%）有肉芽肿（肉芽肿组），1186 例（53.0%）无肉芽肿（非肉芽肿组）。与非肉芽肿组相比，肉芽肿组的复发和再手术次数明显更高（比值比 1.37，P =.04；比值比 2.38，P <.001；分别），且研究间存在显著异质性（P =.06；P <.001；分别）。与非肉芽肿组相比，肉芽肿组的复发和再手术时间明显更短（风险比 1.63，P =.001；风险比 1.62，P =.002；分别），且研究间无显著异质性。在对高质量研究、较近研究和患者人数较多的研究进行敏感性分析时，肉芽肿组的复发和再手术次数仍明显高于非肉芽肿组。
与非肉芽肿性克罗恩病相比，肉芽肿性克罗恩病似乎与更高的复发和再手术次数以及更短的复发和再手术时间相关。由于研究间存在显著异质性，应进一步开展研究以证实这些发现。
