J Crohns Colitis. 2015 Feb;9(2):147-55. doi: 10.1093/ecco-jcc/jju017.
No previous large-scale studies have evaluated the prognosis of ulcerative colitis (UC) over a period of three decades in a non-Caucasian population. The aims of this study were to update the current information on the natural course of UC in a sizable cohort of Korean patients and to evaluate changes in the treatment paradigms and prognosis of UC over time.
We retrospectively analyzed 2802 Korean UC patients who visited Asan Medical Center. We divided the study subjects into three groups based on the year of diagnosis (cohort 1: 1977–1999; cohort 2: 2000–2006; and cohort 3: 2007–2013).
Five-year cumulative probabilities of prescription of thiopurines (azathioprine or 6-mercaptopurine) and anti-tumor necrosis factor (anti-TNF) agents were 4.1% and 0.0%, respectively, in cohort 1 and 27.9% and 12.7%, respectively, in cohort 3 (P < 0.001). A total of 209 patients (7.5%) underwent colectomy, producing cumulative probabilities of colectomy at 10, 20 and 30 years after diagnosis of 7.8%, 14.2% and 21.3%, respectively. The cumulative probability of colectomy was especially low in patients first diagnosed at our center: 3.1% at 10 years and 4.5% at 20 years. Moreover, the cumulative probability of colectomy decreased significantly over the last 30 years (P = 0.039).
Thiopurines and anti-TNF agents are used increasingly more frequently and earlier, while the colectomy rate has decreased over the last 30 years in Korean patients with UC. Korean UC patients may have a better clinical course than Western cases, as indicated by a lower colectomy rate.
既往研究中，尚无大规模、针对非高加索人群溃疡性结肠炎（UC）患者长达三十年病程的研究。本研究旨在更新韩国UC 患者的现状，并评估随时间推移 UC 治疗模式和预后的变化。
我们回顾性分析了 2802 例在我院就诊的韩国 UC 患者。我们根据诊断年份将研究对象分为三组（队列 1：1977-1999 年；队列 2：2000-2006 年；队列 3：2007-2013 年）。
队列 1 和 2 中，噻唑嘌呤（硫唑嘌呤或 6-巯基嘌呤）和抗 TNF 药物处方的 5 年累积概率分别为 4.1%和 0.0%，而队列 3 中分别为 27.9%和 12.7%（P<0.001）。共有 209 例（7.5%）接受了结肠切除术，诊断后 10、20 和 30 年的结肠切除术累积概率分别为 7.8%、14.2%和 21.3%。在我们中心首次确诊的患者中，结肠切除术的累积概率尤其低：10 年时为 3.1%，20 年时为 4.5%。此外，过去 30 年来结肠切除术的累积概率显著下降（P=0.039）。
在过去 30 年中，韩国 UC 患者接受硫唑嘌呤和抗 TNF 药物治疗的频率越来越高、时间越来越早，而结肠切除术的比例则有所下降。韩国 UC 患者的临床病程可能优于西方患者，表现在结肠切除术比例较低。
