Cerqueira Rute M, Lago Paula
Gastroenterologia, Centro Hospitalar Entre Douro e Vouga, Santa Maria Feira, Portugal.
Acta Med Port. 2011 Dec;24 Suppl 4:1057-62. Epub 2011 Dec 31.
Crohn's disease (CD) is a progressive disease that is subdivided in three phenotypes: inflammatory, stricturing, and penetrating. At diagnosis most CD patients have inflammatory disease. However, the natural history of CD evolves over time to structural digestive tract complications (strictures and fistulae) which are associated with hospitalisations and surgeries. Nowadays, there is evidence that early treatment with immunosuppressants and biologics can interrupt the development of inflammation- destruction/fibrosis through its potential to induce complete mucosal healing. The change in CD natural history, mediated by mucosal healing, is associated with a reduction in serious complications (hospitalisations and surgeries). Nevertheless, the clinical course of CD varies considerably between patients and there is still no definition for the timing of immunosuppressants and/or biologics use. This medication is associated to certain risks (lymphomas and opportunistic infections) and the difficulty to predict, on an individual basis, the progression to complications have triggered efforts to identify risk factors that allow at diagnosis to classify patients in high and low risk groups and to tailor therapy. This paper is an updated compilation of evidence of clinical risk factors predictive for CD complications.
克罗恩病（CD）是一种进行性疾病，可细分为三种表型：炎症型、狭窄型和穿透型。在诊断时，大多数CD患者患有炎症性疾病。然而，CD的自然病程会随着时间的推移发展为结构性消化道并发症（狭窄和瘘管），这些并发症与住院和手术相关。如今，有证据表明，使用免疫抑制剂和生物制剂进行早期治疗可以通过诱导完全黏膜愈合的潜力来中断炎症-破坏/纤维化的发展。由黏膜愈合介导的CD自然病程的改变与严重并发症（住院和手术）的减少相关。然而，CD患者的临床病程差异很大，对于免疫抑制剂和/或生物制剂的使用时机仍没有明确的定义。这种药物存在一定风险（淋巴瘤和机会性感染），而且难以根据个体情况预测并发症的进展，这促使人们努力寻找风险因素，以便在诊断时将患者分为高风险和低风险组，并进行个性化治疗。本文是对预测CD并发症的临床风险因素证据的最新汇总。
