Department of GI and Pancreatic Surgery, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
Dis Colon Rectum. 2011 Sep;54(9):1147-54. doi: 10.1097/DCR.0b013e318222ddc3.
The frequency of Crohn's disease in China is increasing, but few reports are available on clinical features, phenotypes according to the Montreal classification, or risk factors for surgery in mainland China.
This study aimed to assess clinical presentation, phenotypes according to the Montreal classification, and potential risk factors for initial surgery in patients with Crohn's disease in southern China.
This was an observational study designed as a retrospective analysis of a historical cohort.
The study was conducted at a tertiary referral hospital, Guangzhou, China.
Medical records of 212 consecutive patients with Crohn's disease were reviewed; data from 205 patients who met inclusion criteria were analyzed.
The value of age, location, and behavior of disease according to the Montreal system, smoking behavior, and other clinical variables as potential risk factors in predicting the requirement for initial surgery was assessed by use of Cox regression analysis.
A total of 205 patients were studied. Abdominal pain (181 patients, 88.3%) was the most common clinical presentation. At the time of diagnosis, age was between 17 and 40 years in 145 patients (70.7%). The Montreal classification of disease location was L3 (ileocolonic) in 114 patients (55.6%), disease behavior was classified as inflammatory in 133 patients (64.9%). During the course of their disease (median, 4 years; range, 1-21 years), 79 patients (38.5%) required bowel resection. Kaplan-Meier analysis showed that the overall cumulative rate of primary bowel surgery was 17.6% at 1 year after onset of symptoms, 20.3% at 2 years, 35.2% at 5 years, and 58.3% at 10 years. In our final Cox model, stricturing (HR, 3.67; 95% CI, 2.14-6.29; P < .001), penetrating behavior (HR, 4.60; 95% CI, 2.58-8.22; P < .001), and smoking habit (HR, 2.02; 95% CI, 1.15-3.53; P = .014) were significantly associated with an increased risk for bowel resection.
The study was limited by its retrospective nature.
In Chinese patients with Crohn's disease, abdominal pain is the most common clinical presentation, and the most common phenotypes are age 17 to 40 years at diagnosis, ileocolonic disease location, and inflammatory disease behavior. More than one-third of patients require surgery at a median of 4 years after onset of symptoms. Stricturing, penetrating disease, and smoking are associated with an increased risk of requiring bowel resection.
中国克罗恩病的发病率正在增加，但关于其临床特征、根据蒙特利尔分类的表型以及手术风险因素的报道很少。
本研究旨在评估中国南方地区克罗恩病患者的临床表现、根据蒙特利尔分类的表型以及初次手术的潜在风险因素。
这是一项观察性研究，设计为历史队列的回顾性分析。
中国广州的一家三级转诊医院。
回顾性分析了 212 例连续克罗恩病患者的病历；对符合纳入标准的 205 例患者的数据进行了分析。
使用 Cox 回归分析评估年龄、疾病根据蒙特利尔系统的部位和行为、吸烟行为和其他临床变量作为预测初次手术需求的潜在风险因素的价值。
共纳入 205 例患者。腹痛（181 例，88.3%）是最常见的临床表现。在诊断时，145 例（70.7%）患者年龄在 17 至 40 岁之间。疾病部位的蒙特利尔分类为 L3（回肠结肠）的有 114 例（55.6%），疾病行为分类为炎症的有 133 例（64.9%）。在疾病过程中（中位数 4 年；范围 1-21 年），79 例（38.5%）需要肠切除术。Kaplan-Meier 分析显示，症状出现后 1 年、2 年、5 年和 10 年的总体初次肠手术累积率分别为 17.6%、20.3%、35.2%和 58.3%。在我们的最终 Cox 模型中，狭窄（HR，3.67；95%CI，2.14-6.29；P<0.001）、穿透行为（HR，4.60；95%CI，2.58-8.22；P<0.001）和吸烟习惯（HR，2.02；95%CI，1.15-3.53；P=0.014）与肠切除术风险增加显著相关。
研究受到其回顾性性质的限制。
在中国克罗恩病患者中，腹痛是最常见的临床表现，最常见的表型是诊断时年龄为 17 至 40 岁、回肠结肠疾病部位和炎症性疾病行为。超过三分之一的患者在症状出现后中位数 4 年需要手术。狭窄、穿透性疾病和吸烟与需要肠切除术的风险增加相关。
