Department of Gastroenterology, St Vincent's Hospital and University of Melbourne, Melbourne, VIC, Australia.
Department of Gastroenterology, St Vincent's Hospital and University of Melbourne, Melbourne, VIC, Australia
J Crohns Colitis. 2015 Jun;9(6):452-62. doi: 10.1093/ecco-jcc/jjv058. Epub 2015 Apr 8.
Patients with Crohn's disease have poorer health-related quality of life [HRQoL] than healthy individuals, even when in remission. Although HRQoL improves in patients who achieve drug-induced or surgically induced remission, the effects of surgery overall have not been well characterised.
In a randomised trial, patients undergoing intestinal resection of all macroscopically diseased bowel were treated with postoperative drug therapy to prevent disease recurrence. All patients were followed prospectively for 18 months. C-reactive protein [CRP], Crohn's Disease Activity Index [CDAI], and faecal calprotectin [FC] were measured preoperatively and at 6, 12, and 18 months. HRQoL was assessed with a general [SF36] and disease-specific [IBDQ] questionnaires at the same time points.
A total of 174 patients were included. HRQoL was poor preoperatively but improved significantly [p < 0.001] at 6 months postoperatively. This improvement was sustained at 18 months. Females and smokers had a poorer HRQoL when compared with males and non-smokers, respectively. Persistent endoscopic remission, intensification of drug treatment at 6 months, and anti-tumour necrosis factor therapy were not associated with HRQoL outcomes different from those when these factors were not present. There was a significant inverse correlation between CDAI, [but not endoscopic recurrence, CRP, or FC] on HRQoL.
Intestinal resection of all macroscopic Crohn's disease in patients treated with postoperative prophylactic drug therapy is associated with significant and sustained improvement in HRQoL irrespective of type of drug treatment or endoscopic recurrence. HRQoL is lower in female patients and smokers. A higher CDAI, but not direct measures of active disease or type of drug therapy, is associated with a lower HRQoL.
患有克罗恩病的患者的健康相关生活质量（HRQoL）比健康个体差，即使处于缓解期也是如此。尽管在实现药物诱导或手术诱导缓解的患者中，HRQoL 会得到改善，但手术的总体效果尚未得到很好的描述。
在一项随机试验中，接受所有宏观疾病肠段切除术的患者接受术后药物治疗以预防疾病复发。所有患者均前瞻性随访 18 个月。术前及术后 6、12 和 18 个月测量 C 反应蛋白（CRP）、克罗恩病活动指数（CDAI）和粪便钙卫蛋白（FC）。同时在相同时间点使用一般健康问卷（SF36）和疾病特异性问卷（IBDQ）评估 HRQoL。
共纳入 174 例患者。术前 HRQoL 较差，但术后 6 个月显著改善（p<0.001）。这种改善在 18 个月时仍持续存在。与男性和非吸烟者相比，女性和吸烟者的 HRQoL 较差。内镜缓解持续存在、6 个月时药物治疗强化以及使用抗 TNF 治疗与不存在这些因素时的 HRQoL 结果没有差异。CDAI 与 HRQoL 呈显著负相关（但内镜复发、CRP 或 FC 与 HRQoL 无相关性）。
在接受术后预防性药物治疗的患者中，对所有宏观克罗恩病肠段进行切除术与 HRQoL 的显著和持续改善相关，而与药物治疗类型或内镜复发无关。女性患者和吸烟者的 HRQoL 较低。较高的 CDAI，但不是直接衡量疾病活动度或药物治疗类型，与较低的 HRQoL 相关。
