克罗恩病术后复发：一项为期5年的前瞻性研究。

Post-operative recurrence of Crohn's disease: A prospective study at 5 years.

作者信息

Onali Sara, Calabrese Emma, Petruzziello Carmelina, Lolli Elisabetta, Ascolani Marta, Ruffa Alessandra, Sica Giuseppe, Rossi Alessandra, Chiaramonte Carlo, Pallone Francesco, Biancone Livia

机构信息

GI Unit, Department of Systems Medicine, University of Rome "Tor Vergata", Italy.

Surgical Unit, Department of Surgery, University of Rome "Tor Vergata", Italy.

出版信息

Dig Liver Dis. 2016 May;48(5):489-494. doi: 10.1016/j.dld.2016.01.009. Epub 2016 Jan 29.

DOI:10.1016/j.dld.2016.01.009

PMID:26905749

Abstract

BACKGROUND

We aimed to prospectively assess whether endoscopic recurrence severity at 1 year in Crohn's disease is predictive of clinical recurrence within 5 years.

METHODS

Clinical recurrence (Crohn's Disease Activity Index>150) was assessed yearly for 5 years in Crohn's disease patients undergoing ileo-colonic resection. At 1 year, recurrence was assessed by colonoscopy (Rutgeerts' score ≥i1 or ≥2i) and small intestine contrast ultrasonography.

RESULTS

40 patients were included (23 males, median age 39 [16-69] years). Clinical recurrence occurred within 5 years in 16 (40%) patients (years 1, 2, 3, 4, 5: 2 [5%]; 10 [25%]; 4 [10%]; 2 [5%]; 4 [10%], respectively). At 1 year, endoscopic recurrence (score≥i1) occurred in 39 (97.5%) patients (score≥i2: 33 [82.5%]). Ultrasound detected lesions compatible with recurrence in 39/40 (97.5%) patients. Endoscopic score at 1 year was correlated with clinical score at 2 years (p=0.007; r=0.41). Endoscopic score at 1 year was higher in patients with (n=10) vs without (n=30) clinical recurrence at 2 years (3 [2-4] vs 2 [0-4]; p=0.003). Higher endoscopic score (>i2) at 1 year was a risk factor for clinical recurrence within 5 years (OR=0.18; 95% CI 0.04-0.71; p=0.008).

CONCLUSIONS

In Crohn's disease, severity of endoscopic recurrence at 1 year remains a predictive marker of clinical recurrence within 5 years. Small intestine contrast ultrasonography is useful for assessing 1-year recurrence.

摘要

背景

我们旨在前瞻性评估克罗恩病患者1年时内镜复发的严重程度是否可预测5年内的临床复发情况。

方法

对接受回结肠切除术的克罗恩病患者进行为期5年的年度临床复发情况评估（克罗恩病活动指数>150）。在1年时，通过结肠镜检查（ Rutgeerts评分≥i1或≥2i）和小肠造影超声检查评估复发情况。

结果

纳入40例患者（23例男性，中位年龄39[16 - 69]岁）。16例（40%）患者在5年内出现临床复发（第1、2、3、4、5年分别为2例[5%]；10例[25%]；4例[10%]；2例[5%]；4例[10%]）。在1年时，39例（97.5%）患者出现内镜复发（评分≥i1）（评分≥i2：33例[82.5%]）。超声在39/40（97.5%）例患者中检测到与复发相符的病变。1年时的内镜评分与2年时的临床评分相关（p = 0.007；r = 0.41）。2年时出现临床复发的患者（n = 10）与未出现临床复发的患者（n = 30）相比，1年时的内镜评分更高（3[2 - 4]比2[0 - 4]；p = 0.003）。1年时较高的内镜评分（>i2）是5年内临床复发的危险因素（OR = 0.18；95%CI 0.04 - 0.71；p = 0.008）。