硫唑嘌呤治疗时机和时间对克罗恩病首次肛周手术的影响：英国基于人群的研究（1995-2009 年）。

Impact of timing and duration of thiopurine treatment on first perianal surgery in Crohn's disease: UK population-based study (1995-2009).

机构信息

*Department of Gastroenterology, St George's University Hospital, London, United Kingdom; †Department of Primary Care and Public Health, Imperial College, London, United Kingdom; ‡Department of Gastroenterology, St James University Hospital, Leeds, United Kingdom; and §Department of Computing, Imperial College, London, United Kingdom.

出版信息

Inflamm Bowel Dis. 2015 Feb;21(2):385-91. doi: 10.1097/MIB.0000000000000290.

DOI:10.1097/MIB.0000000000000290

PMID:25569740

Abstract

BACKGROUND

The impact of thiopurine (TP) use on perianal surgery is uncertain. Our aim was to determine trends in perianal surgery and the impact of timing and duration of TPs on the risk of first perianal surgery.

METHODS

We identified a population-based cohort of incident cases of Crohn's disease between 1995 and 2009. We used Kaplan-Meier analysis to determine trends in TP usage and first perianal surgery by era of diagnosis: era 1 (1995-2002) and era 2 (2003-2009). We quantified the impact of duration and timing of TPs on the risk of perianal surgery using a Cox regression model.

RESULTS

We identified a cohort of 5235 incident cases of Crohn's disease. The 5-year cumulative probability of first perianal surgery decreased from 2.7% to 1.7% between era 1 and era 2, respectively (P = 0.03). TP use for greater than 18 months was associated with a 40% risk reduction for first perianal surgery (hazard ratio: 0.60, 95% confidence interval: 0.39-0.95) and 49% if TPs were used for 2 years or more (hazard ratio: 0.51, 95% confidence interval: 0.32-0.99). There was no demonstrable additional benefit from early TP use within the first year after diagnosis (hazard ratio: 0.85, 95% confidence interval: 0.52-1.40, P = 0.53).

CONCLUSIONS

Over the past 15 years, TP use has increased by 50%, whereas perianal surgery rates have decreased by 37% among UK population with Crohn's disease. Sustained use for 18 months was associated with a reduced risk of perianal surgery by almost a half in the first 5 years after diagnosis.

摘要

背景

硫嘌呤（TP）的使用对肛周手术的影响尚不确定。我们的目的是确定肛周手术的趋势，以及 TP 的使用时间和持续时间对首次肛周手术风险的影响。

方法

我们确定了 1995 年至 2009 年间发生的克罗恩病的人群队列。我们使用 Kaplan-Meier 分析来确定诊断时代的 TP 使用和首次肛周手术的趋势：时代 1（1995-2002）和时代 2（2003-2009）。我们使用 Cox 回归模型来量化 TP 使用时间和持续时间对肛周手术风险的影响。

结果

我们确定了一个 5235 例克罗恩病的队列。在时代 1 和时代 2 之间，首次肛周手术的 5 年累积概率分别从 2.7%降至 1.7%（P=0.03）。TP 使用时间超过 18 个月与首次肛周手术的风险降低 40%相关（风险比：0.60，95%置信区间：0.39-0.95），如果使用 TP 超过 2 年，风险降低 49%（风险比：0.51，95%置信区间：0.32-0.99）。在诊断后第一年早期使用 TP 并没有表现出明显的额外益处（风险比：0.85，95%置信区间：0.52-1.40，P=0.53）。