Rinawi Firas, Assa Amit, Hartman Corina, Mozer Glassberg Yael, Nachmias Friedler Vered, Rosenbach Yoram, Silbermintz Ari, Zevit Noam, Shamir Raanan
Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center of Israel, Petach-Tikva.
Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.
J Clin Gastroenterol. 2018 Apr;52(4):326-332. doi: 10.1097/MCG.0000000000000741.
Data describing extent change (progression or regression) in pediatric-onset ulcerative colitis (UC) are scarce.
We aimed to describe extent change in pediatric-onset UC during long-term follow-up and to assess predictors of extent change.
Medical charts of pediatric-onset UC patients with at least 5-year follow-up were analyzed retrospectively. Disease extent was determined using the Paris classification. It was examined at diagnosis and during follow-up at different time points. The impact of possible predictors on extent change including age at diagnosis, gender, clinical manifestations, disease, severity indices, and different therapeutic regimens during disease course was assessed.
Patients (n=134, 55% males) were followed for a median duration of 13.1 (range, 5 to 28) years. Median age at diagnosis was 13.1 (range, 2 to 17.8) years. Of 134 patients, 40.5% had extensive or pancolitis, 33.5% left-sided colitis, and 26% had proctitis at diagnosis. On follow-up (n=117), 45% had unchanged disease extent, 35% experienced extent progression, whereas 20% experienced regression of disease extent. The multivariate Cox models demonstrated that among children with left-sided disease at diagnosis, presence of extraintestinal manifestations (hazard ratio, 5.19; P=0.022), and higher pediatric UC activity index (hazard ratio, 8.77; P=0.008) were associated with extent progression to extensive disease. Predictors of extent regression have not been identified.
Disease extent changes significantly over time in pediatric-onset UC. In our cohort, presence of extraintestinal manifestation and higher pediatric UC activity index score at diagnosis were associated with progression from limited to extensive disease during follow-up.
描述儿童期起病的溃疡性结肠炎（UC）范围变化（进展或消退）的数据稀少。
我们旨在描述儿童期起病的UC在长期随访期间的范围变化，并评估范围变化的预测因素。
对至少随访5年的儿童期起病的UC患者的病历进行回顾性分析。使用巴黎分类法确定疾病范围。在诊断时以及随访期间的不同时间点进行检查。评估了可能的预测因素对范围变化的影响，包括诊断时的年龄、性别、临床表现、疾病严重程度指数以及疾病过程中的不同治疗方案。
患者（n = 134，55%为男性）的中位随访时间为13.1年（范围5至28年）。诊断时的中位年龄为13.1岁（范围2至17.8岁）。在134例患者中，40.5%在诊断时有广泛性或全结肠炎，33.5%为左侧结肠炎，26%为直肠炎。在随访时（n = 117），45%的患者疾病范围未改变，35%经历了范围进展，而20%经历了疾病范围的消退。多变量Cox模型表明，在诊断时患有左侧疾病的儿童中，肠外表现的存在（风险比，5.19；P = 0.022）以及较高的儿童UC活动指数（风险比，8.77；P = 0.008）与范围进展至广泛性疾病相关。尚未确定范围消退的预测因素。
儿童期起病的UC的疾病范围随时间显著变化。在我们的队列中，诊断时肠外表现的存在和较高的儿童UC活动指数评分与随访期间从局限性疾病进展为广泛性疾病相关。
