NIHR Clinical Lecturer in Surgery, NIHR Nottingham Digestive Disease Centre and Biomedical Research Unit, Department of Surgery, QMC Campus, E Floor, West Block, Nottingham University Hospital NHS Trust, Derby Road, Nottingham NG7 2UH, UK.
Gut. 2012 Jan;61(1):95-100. doi: 10.1136/gut.2011.238808. Epub 2011 May 6.
To determine the risk of developing complicated colonic diverticular disease (CCDD) with prior episodes of acute diverticulitis and determine the mortality of the spectrum of CCDD.
Population-based cohort study.
Computerised records from the General Practice Research Database linked to Hospital Episode Statistics data from the UK.
Patients and controls registered in the General Practice Research Database from 1990 to 2007.
Mortality was calculated and Cox regression modelling used to provide adjusted HRs and 95% CI. Logistic regression was used to model the effect of prior acute diverticulitis on the development of complications.
2950 patients (1872 (63.5%) female) had a diagnosis of CCDD (8739 controls). A total of 1042 (35.3%) patients died compared with 2062 (23.6%) controls. Most excess deaths occurred in the first year after the complication. Patients with a perforation/abscess had a 4.5-fold increase in 1-year mortality (HR 4.55, 95% CI 3.74 to 5.52) compared with the general population, whereas those with a fistula or stricture had a 2.5-fold increase in mortality (fistula HR 2.60, 95% CI 1.47 to 4.62; stricture HR 2.41, 95% CI 1.86 to 3.11). Although most patients (2133 (72.3%)) had suffered no prior episodes of acute diverticulitis, increasing episodes of acute diverticulitis were associated with an increased risk of developing a fistula (two or more prior episodes, OR 1.54 95%, CI 1.08 to 2.19), but there was no clear relationship with stricture or perforation/abscess.
Although most patients have experienced no prior episodes of acute diverticulitis, fistula formation is preceded by bouts of inflammation. Excess 1-year mortality across the spectrum of CCDD compared with the general population is substantial.
确定既往急性憩室炎发作与复杂结肠憩室病（CCDD）发展风险的关系，并确定 CCDD 谱的死亡率。
基于人群的队列研究。
英国的全科医学研究数据库与医院发病统计数据的计算机记录相链接。
1990 年至 2007 年期间注册于全科医学研究数据库的患者和对照者。
计算死亡率，并采用 Cox 回归模型提供调整后的 HR 和 95%CI。采用 logistic 回归模型分析既往急性憩室炎对并发症发生的影响。
2950 例患者（1872 例[63.5%]为女性）诊断为 CCDD（8739 例对照者）。与对照组相比，共有 1042 例（35.3%）患者死亡。大多数超额死亡发生在并发症发生后的 1 年内。穿孔/脓肿患者的 1 年死亡率增加了 4.5 倍（HR 4.55，95%CI 3.74 至 5.52），而瘘管或狭窄患者的死亡率增加了 2.5 倍（瘘管 HR 2.60，95%CI 1.47 至 4.62；狭窄 HR 2.41，95%CI 1.86 至 3.11）。尽管大多数患者（2133 例[72.3%]）既往无急性憩室炎发作，但急性憩室炎发作次数增加与瘘管形成风险增加相关（两次或更多次发作，OR 1.54，95%CI 1.08 至 2.19），但与狭窄或穿孔/脓肿无明显关系。
尽管大多数患者既往无急性憩室炎发作，但瘘管形成之前存在炎症发作。与一般人群相比，CCDD 谱中所有患者的 1 年超额死亡率都相当高。
