炎症是溃疡性结肠炎患者结直肠肿瘤的独立危险因素：一项病例对照研究。
Inflammation is an independent risk factor for colonic neoplasia in patients with ulcerative colitis: a case-control study.
机构信息
Department of Medicine, University of Chicago Medical Center, Chicago, Illinois.
出版信息
Clin Gastroenterol Hepatol. 2013 Dec;11(12):1601-8.e1-4. doi: 10.1016/j.cgh.2013.06.023. Epub 2013 Jul 17.
BACKGROUND & AIMS: An association between inflammatory activity and colorectal neoplasia (CRN) has been documented in patients with ulcerative colitis (UC). However, previous studies did not address the duration of inflammation or the effects of therapy on risk for CRN. We investigated the effects of inflammation, therapies, and characteristics of patients with UC on their risk for CRN.
METHODS
We collected data from 141 patients with UC without CRN (controls) and 59 matched patients with UC who developed CRN (cases), comparing disease extent and duration and patients' ages. We used a new 6-point histologic inflammatory activity (HIA) scale to score biopsy fragments (n = 4449). Information on medications, smoking status, primary sclerosing cholangitis, and family history of CRN were collected from the University of Chicago Inflammatory Bowel Disease Endoscopy Database. Relationships between HIA, clinical features, and CRN were assessed by conditional logistic regression.
RESULTS
Cases and controls were similar in numbers of procedures and biopsies, exposure to steroids or mesalamine, smoking status, and family history of CRN. They differed in proportion of men vs women, exposure to immune modulators, and primary sclerosing cholangitis prevalence. In univariate analysis, HIA was positively associated with CRN (odds ratio [OR], 2.56 per unit increase; P = .001), whereas immune modulators (including azathioprine, 6-mercaptopurine, and methotrexate) reduced the risk for CRN (OR, 0.35; P < .01). HIA was also associated with CRN in multivariate analysis (OR, 3.68; P = .001).
CONCLUSIONS
In a case-control study, we associated increased inflammation with CRN in patients with UC. Use of immune modulators reduced the risk for CRN, indicating that these drugs have chemoprotective effects. On the basis of these data, we propose new stratified surveillance and treatment strategies to prevent and detect CRN in patients with UC.
背景与目的
溃疡性结肠炎（UC）患者的炎症活动与结直肠肿瘤（CRN）之间存在关联。然而，既往研究并未探讨炎症持续时间或治疗对 CRN 风险的影响。本研究旨在调查 UC 患者的炎症、治疗及患者特征对其 CRN 风险的影响。
方法
我们收集了 141 例无 CRN 的 UC 患者（对照组）和 59 例发生 CRN 的 UC 患者（病例组）的数据，比较了疾病范围和持续时间以及患者年龄。我们使用新的 6 分组织学炎症活动（HIA）量表对活检片段进行评分（n=4449）。从芝加哥大学炎症性肠病内镜数据库收集了药物、吸烟状况、原发性硬化性胆管炎和 CRN 家族史的信息。通过条件逻辑回归评估 HIA 与临床特征和 CRN 之间的关系。
结果
病例组和对照组在操作和活检次数、激素或美沙拉嗪暴露、吸烟状况和 CRN 家族史方面相似。但在男女比例、免疫调节剂暴露和原发性硬化性胆管炎患病率方面存在差异。单因素分析显示，HIA 与 CRN 呈正相关（每增加一个单位，比值比[OR]为 2.56；P=0.001），而免疫调节剂（包括硫唑嘌呤、6-巯基嘌呤和甲氨蝶呤）降低了 CRN 的风险（OR 为 0.35；P<0.01）。多因素分析也显示 HIA 与 CRN 相关（OR 为 3.68；P=0.001）。
结论
在病例对照研究中，我们发现 UC 患者炎症增加与 CRN 相关。免疫调节剂的使用降低了 CRN 的风险，表明这些药物具有化学预防作用。基于这些数据，我们提出了新的分层监测和治疗策略，以预防和检测 UC 患者的 CRN。
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