Magro Fernando, Dias Cláudia C, Coelho Rosa, Santos Paula M, Fernandes Samuel, Caetano Cidalina, Rodrigues Ângela, Portela Francisco, Oliveira Ana, Ministro Paula, Cancela Eugénia, Vieira Ana I, Barosa Rita, Cotter José, Carvalho Pedro, Cremers Isabelle, Trabulo Daniel, Caldeira Paulo, Antunes Artur, Rosa Isadora, Moleiro Joana, Peixe Paula, Herculano Rita, Gonçalves Raquel, Gonçalves Bruno, Tavares Sousa Helena, Contente Luís, Morna Henrique, Lopes Susana
1Department of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Porto, Portugal; 2MedInUP-Centre for Drug Discovery and Innovative Medicines, University of Porto, Porto, Portugal; 3MEDCIDS-Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine of the University of Porto, Porto, Portugal; 4CINTESIS-Centre for Health Technology and Services Research, Porto, Portugal; 5Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal; 6Gastroenterology Department, Centro Hospitalar Lisboa Norte, Hospital de Santa Maria, Portugal; 7Gastroenterology Department, Centro Hospitalar do Porto, Portugal; 8Gastroenterology Department, Centro Hospitalar e Universitário de Coimbra, Portugal; 9Gastroenterology Department, Centro Hospitalar Tondela e Viseu, Portugal; 10Gastroenterology Department, Hospital Garcia da Orta, Lisboa, Portugal; 11Gastroenterology Department, Hospital Senhora da Oliveira, Guimarães, Portugal; 12Gastroenterology Department, Centro Hospitalar de Setúbal, Hospital S. Bernardo, Portugal; 13Department of Biomedical Sciences and Medicine, University of Algarve; 14Gastroenterology Department, Hospital de Faro, Portugal; 15Instituto Português de Oncologia de Lisboa; 16Gastroenterology Department, Centro Hospitalar Lisboa Oriental, Portugal; 17Gastroenterology Department, Hospital de Braga, Portugal; 18Gastroenterology Department, Portimão Unit, Centro Hospitalar do Algarve, Portugal; and 19Gastroenterology Department, Hospital Nélio Mendonça, Funchal, Portugal.
Inflamm Bowel Dis. 2017 Feb;23(2):289-297. doi: 10.1097/MIB.0000000000001007.
The definition of early therapeutic strategies to control Crohn's disease aggressiveness and prevent recurrence is key to improve clinical practice. This study explores the impact of early surgery and immunosuppression onset in the occurrence of disabling outcomes.
This was a multicentric and retrospective study with 754 patients with Crohn's disease, who were stratified according to the need for an early surgery (group S) or not (group I) and further divided according to the time elapsed from the beginning of the follow-up to the start of immunosuppression therapy.
The rate of disabling events was similar in both groups (S: 77% versus I: 76%, P = 0.700). The percentage of patients who needed surgery after or during immunosuppression therapy was higher among group S, both for first surgeries after the index event (38% of groups S versus 21% of group I, P < 0.001) and for reoperations (38% of groups S versus 12% of group I, P < 0.001). The time elapsed to reoperation was shorter in group I (HR = 2.340 [1.367-4.005]), stratified for the onset of immunosuppression. Moreover, reoperation was far more common among patients who had a late start of immunosuppression (S36: 50% versus S0-6: 27% and S6-36: 25%, P < 0.001) and (I36: 16% versus I0-6: 5% and I6-36: 7%, P < 0.001).
Although neither early surgery nor immunosuppression seem to be able to prevent global disabling disease, an early start of immunosuppression by itself is associated with fewer surgeries and should be considered in daily practice as a preventive strategy.
确定控制克罗恩病侵袭性及预防复发的早期治疗策略是改善临床实践的关键。本研究探讨早期手术和免疫抑制治疗开始时间对致残性结局发生情况的影响。
这是一项多中心回顾性研究，纳入754例克罗恩病患者，根据是否需要早期手术分为两组（S组和I组），并根据从随访开始到免疫抑制治疗开始的时间进一步划分。
两组致残事件发生率相似（S组：77%，I组：76%，P = 0.700）。S组中在免疫抑制治疗期间或之后需要手术的患者百分比更高，无论是首次手术（S组38%，I组21%，P < 0.001）还是再次手术（S组38%，I组12%，P < 0.001）。I组再次手术的时间更短（风险比=2.340 [1.367 - 4.005]），按免疫抑制治疗开始时间分层。此外，免疫抑制治疗开始较晚的患者再次手术更为常见（S36组：50%，S0 - 6组：27%，S6 - 36组：25%，P < 0.001）以及（I36组：16%，I0 - 6组：5%，I6 - 36组：7%，P < 0.001）。
虽然早期手术和免疫抑制似乎都无法预防整体致残性疾病，但早期开始免疫抑制本身与更少的手术相关，在日常实践中应作为一种预防策略加以考虑。
