Jussila Airi, Virta Lauri J, Pukkala Eero, Färkkilä Martti A
Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland; Seinäjoki Central Hospital, Seinäjoki, Finland.
Social Insurance Institution, Research Department, Turku, Finland.
J Crohns Colitis. 2014 Sep;8(9):1088-96. doi: 10.1016/j.crohns.2014.02.015. Epub 2014 Mar 12.
Increased mortality has been reported in Crohn's disease (CD) but mostly not in ulcerative colitis (UC). We evaluated the overall and cause-specific mortality in a nationwide cohort of patients with inflammatory bowel disease (IBD) in Finland.
A total of 21,964 patients with IBD (16,649 with UC and 5315 with CD) from the Special Reimbursement register were diagnosed 1987-1993 and 2000-2007 and followed up to the end of 2010 by collating these figures with the national computerized Cause-of-Death Register of Statistics Finland. In each cause-of-death category, the number of deaths reported was compared to that expected in general population, and expressed as a standardized mortality ratio (SMR).
Overall mortality was increased among patients with CD (SMR 1.33, 95% confidence interval 1.21-1.46) and UC (1.10, 1.05-1.15). SMR was significantly increased for gastrointestinal causes in CD (6.53, 4.91-8.52) and UC (2.81, 2.32-3.34). Patients with UC were found also to have increased SMR from pulmonary (1.24, 1.02-1.46) and cardiovascular disease (1.14, 1.06-1.22) and cancers of the colon (1.90, 1.38-2.55), rectum (1.79, 1.14-2.69) and biliary tract (5.65, 3.54-8.54), whereas SMR from alcohol-related deaths was decreased (0.54, 0.39-0.71). Patients with CD had a significantly increased SMR for pulmonary diseases (2.01, 1.39-2.80), infections (4.27, 2.13-7.63) and cancers of the biliary tract (4.51, 1.23-11.5) and lymphoid and hematopoietic tissue (2.95, 1.85-4.45).
In this Finnish nationwide study increased overall mortality in both CD and UC was observed. The excess mortality of 14% in IBD is mainly due to deaths related to inflammation in the gut.
据报道，克罗恩病（CD）患者的死亡率有所上升，但溃疡性结肠炎（UC）患者大多并非如此。我们评估了芬兰全国范围内炎症性肠病（IBD）患者的总体死亡率和死因特异性死亡率。
从特殊报销登记册中选取了1987 - 1993年及2000 - 2007年被诊断的21964例IBD患者（16649例UC患者和5315例CD患者），并通过将这些数据与芬兰国家计算机化死因登记册进行核对，随访至2010年底。在每个死因类别中，将报告的死亡人数与一般人群预期的死亡人数进行比较，并表示为标准化死亡率（SMR）。
CD患者（SMR 1.33，95%置信区间1.21 - 1.46）和UC患者（1.10，1.05 - 1.15）的总体死亡率均有所上升。CD患者（6.53，4.91 - 8.52）和UC患者（2.81，2.32 - 3.34）因胃肠道原因导致的SMR显著升高。还发现UC患者肺部（1.24，1.02 - 1.46）、心血管疾病（1.14，1.06 - 1.22）以及结肠（1.90，1.38 - 2.55）、直肠（1.79，1.14 - 2.69）和胆道（5.65，3.54 - 8.54）癌症的SMR升高，而与酒精相关死亡的SMR降低（0.54，0.39 - 0.71）。CD患者肺部疾病（2.01，1.39 - 2.80）、感染（4.27，2.13 - 7.63）以及胆道（4.51，1.23 - 11.5）和淋巴及造血组织（2.95，1.85 - 4.45）癌症的SMR显著升高。
在这项芬兰全国性研究中，观察到CD和UC患者的总体死亡率均有所上升。IBD患者14%的额外死亡率主要归因于与肠道炎症相关的死亡。
