Ouaz Afef, Fekih Monia, Labidi Asma, Ben Mustapha Nadia, Serghini Meriem, Zouiten Lilia, Boubaker Jalel, Filali Azza
Tunis Med. 2016 Jun;94(6):167-170.
Background - Crohn's disease is a clinically heterogeneous condition. Our aim was to identify the phenotype evolution of Crohn's disease over time according to the Montreal Classification and to precise predictive factors of the need for immunosuppressant treatment or surgery. Methods - We included Crohn's disease patients who were followed up for at least 5 years. We excluded patients who were lost to follow up before five. Patients were classified according to the Montreal classification for phenotype at diagnosis and five years later. The evolution of phenotype over time and the need for surgery, immunosuppressive or immunomodulatory drugs were evaluated. Results - One hundred twenty consecutive patients were recruited: 70 males and 50 females. At diagnosis, 68% of patients belong to A2 as determined by the Montreal classification. Disease was most often localized in the colon. The disease location in Crohn's disease remains relatively stable over time, with 93.4% of patients showing no change in disease location. Crohn's disease phenotype changed during follow up, with an increase in stricturing and penetrating phenotypes from 6% to 11% after 5 years. The only predictive factor of phenotype change was the small bowel involvement (OR=3.7 [1.2-7.6]). During follow-up, 82% of patients have presented a severe disease as attested by the use of immunosuppressive drugs or surgery. The factors associated with the disease severity were: small bowel involvement (L1), the stricturing (B2) and penetrating (B3) phenotypes and perineal lesions (OR=17.3 [8.4-19.7]; 12 [7.6-17.2]; 3[1.7-8.3] and 2.8 [2.2-5.1] respectively), without association with age, sex or smoking habits. Conclusion - Crohn's disease evolves over time: inflammatory diseases progress to more aggressive stricturing and penetrating phenotypes. The ileal location, the stricturing and penetrating forms and perineal lesions were predictive of surgery and immunosuppressant or immunomodulatory treatment.
背景——克罗恩病是一种临床异质性疾病。我们的目的是根据蒙特利尔分类法确定克罗恩病随时间的表型演变，并明确免疫抑制剂治疗或手术需求的预测因素。方法——我们纳入了随访至少5年的克罗恩病患者。我们排除了在5年之前失访的患者。根据诊断时和5年后的表型，按照蒙特利尔分类法对患者进行分类。评估表型随时间的演变以及手术、免疫抑制或免疫调节药物的需求。结果——连续招募了120例患者：70例男性和50例女性。诊断时，根据蒙特利尔分类法，68%的患者属于A2型。疾病最常累及结肠。克罗恩病的病变部位随时间相对稳定，93.4%的患者病变部位无变化。克罗恩病表型在随访期间发生变化，狭窄型和穿透型表型在5年后从6%增加到11%。表型变化的唯一预测因素是小肠受累（比值比=3.7[1.2 - 7.6]）。随访期间，82%的患者使用免疫抑制药物或接受手术，证明患有严重疾病。与疾病严重程度相关的因素有：小肠受累（L1）、狭窄（B2）和穿透（B3）表型以及会阴病变（比值比分别为17.3[8.4 - 19.7]；12[7.6 - 17.2]；3[1.7 - 8.3]和2.8[2.2 - 5.1]），与年龄、性别或吸烟习惯无关。结论——克罗恩病随时间演变：炎症性疾病进展为更具侵袭性的狭窄型和穿透型表型。回肠部位、狭窄和穿透型以及会阴病变可预测手术和免疫抑制或免疫调节治疗。
