Gao Xiang, Yang Rong-Ping, Chen Min-Hu, Xiao Ying-Lian, He Yao, Chen Bai-Li, Hu Pin-Jin
Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-sen University, No.58 Zhongshan Er Road, Guangzhou, PR China.
Scand J Gastroenterol. 2012 Oct;47(10):1181-91. doi: 10.3109/00365521.2012.668931. Epub 2012 Jul 31.
To investigate the risk factors for primary surgery and postoperative recurrence in a cohort of Chinese Crohn's disease (CD) patients.
Medical notes of consecutive diagnosed patients from 2003 until 2010 were reviewed. Fifty-seven postoperative patients--finished regular follow-up--were recruited for postoperative recurrence analysis.
One hundred eleven of 323 (34.4%) patients of this cohort underwent primary surgery. The cumulative frequency of resection was 16.6%, 35.4%, 53%, and 94.5% for 1, 5, 10, and 30 years, respectively, after onset of disease. Male (OR: 1.994; 95% CI: 1.291-3.078, p = 0.002), stricture (OR: 4.832; 95% CI: 3.064-7.621, p = 0.000), or penetrating (OR: 4.923; 95% CI: 3.060-7.919, p = 0.000) were associated with an increased risk for primary surgery, while early use of immunomodulators was (OR: 0.438; 95% CI: 0.218-0.880, p = 0.020) associated with a decreased risk. Fifty-seven (21.1%) patients were diagnosed as postoperative clinical recurrence and the cumulative recurrence rates were 6.1%, 17.1%, and 36.8% for 1, 2, and 3 years, respectively. Perianal disease was associated with an increased risk for clinical recurrence (OR: 5.606; 95% CI: 1.59-19.766, p = 0.007).
The operation frequency is high in CD. Male, penetrating, and stricture diseases are associated with an increased risk for primary surgery while early use of immunomodulators is associated with a decreased risk. The postoperative recurrence rate is also high. Patients with perianal disease are at higher risk for clinical recurrence.
调查一组中国克罗恩病（CD）患者初次手术及术后复发的危险因素。
回顾了2003年至2010年连续确诊患者的病历。招募了57例完成定期随访的术后患者进行术后复发分析。
该队列中323例患者中有111例（34.4%）接受了初次手术。发病后1年、5年、10年和30年的累计切除率分别为16.6%、35.4%、53%和94.5%。男性（比值比：1.994；95%可信区间：1.291 - 3.078，p = 0.002）、狭窄（比值比：4.832；95%可信区间：3.064 - 7.621，p = 0.000）或穿透性病变（比值比：4.923；95%可信区间：3.060 - 7.919，p = 0.000）与初次手术风险增加相关，而早期使用免疫调节剂（比值比：0.438；95%可信区间：0.218 - 0.880，p = 0.020）与风险降低相关。57例（21.1%）患者被诊断为术后临床复发，1年、2年和3年的累计复发率分别为6.1%、17.1%和36.8%。肛周疾病与临床复发风险增加相关（比值比：5.606；95%可信区间：1.59 - 19.766，p = 0.007）。
CD患者手术频率较高。男性、穿透性病变和狭窄性疾病与初次手术风险增加相关，而早期使用免疫调节剂与风险降低相关。术后复发率也较高。肛周疾病患者临床复发风险更高。
