*Department of Gastroenterology, and †Department of Colon and Rectal Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Inflamm Bowel Dis. 2014 Mar;20(3):488-94. doi: 10.1097/01.MIB.0000441203.56196.46.
To date, no large-scale studies have evaluated the prognosis of Crohn's disease (CD) over a period of 3 decades in non-Caucasian populations. The aims of this study were to update the current information on the long-term prognosis of CD using a large series of patients and to evaluate changes in treatment paradigms over time and their impact on the prognosis of CD in Korea.
We retrospectively analyzed 2043 Korean patients with CD who visited the Asan Medical Center. The study subjects were divided into 3 groups according to the year of diagnosis (cohort 1: 1981-2000, cohort 2: 2001-2005, and cohort 3: 2006-2012).
Azathioprine/6-mercaptopurine and anti-tumor necrosis factor agents have been used increasingly more frequently and earlier over the past 30 years, with a 5-year cumulative probability of prescription of 28.9% and 1.4%, respectively, in cohort 1 and 88.1% and 23.7%, respectively, in cohort 3 (P < 0.001). A total of 726 patients (35.5%) underwent intestinal resection, with a cumulative probability of intestinal resection 10, 20, and 30 years after diagnosis of 43.5%, 70.0%, and 76.1%, respectively. The cumulative probability of surgery was significantly lower in cohort 3 than in cohort 1 (P = 0.012). Early use of azathioprine/6-mercaptopurine was significantly associated with delayed need for intestinal resection by multivariate Cox analysis (hazard ratio: 0.63, 95% confidence interval: 0.46-0.85).
Korean patients with CD may have a similar clinical course to Westerners, as indicated by the intestinal resection rate. The surgery rate has decreased over time, and early use of azathioprine/6-mercaptopurine was related to its decrease.
迄今为止，尚无大型研究评估非白种人群中 30 年来克罗恩病（CD）的预后。本研究的目的是使用大量患者更新 CD 长期预后的最新信息，并评估随时间推移治疗模式的变化及其对韩国 CD 预后的影响。
我们回顾性分析了 2043 名就诊于延世医疗院的韩国 CD 患者。研究对象根据诊断年份分为 3 组（队列 1：1981-2000 年；队列 2：2001-2005 年；队列 3：2006-2012 年）。
过去 30 年，巯嘌呤/6-巯基嘌呤和抗肿瘤坏死因子制剂的应用越来越广泛，且应用时间越来越早，队列 1 中 5 年累积处方率分别为 28.9%和 1.4%，而队列 3 中分别为 88.1%和 23.7%（P<0.001）。共有 726 例（35.5%）患者接受了肠切除术，诊断后 10、20 和 30 年的肠切除术累积概率分别为 43.5%、70.0%和 76.1%。队列 3 的手术累积概率明显低于队列 1（P=0.012）。多变量 Cox 分析显示，早期使用巯嘌呤/6-巯基嘌呤与肠切除术的延迟需求显著相关（危险比：0.63，95%置信区间：0.46-0.85）。
韩国 CD 患者的临床病程可能与西方人相似，这反映在肠切除术的发生率上。随着时间的推移，手术率呈下降趋势，早期使用巯嘌呤/6-巯基嘌呤与手术率的下降有关。
