Rinawi Firas, Assa Amit, Eliakim Rami, Mozer-Glassberg Yael, Nachmias-Friedler Vered, Niv Yaron, Rosenbach Yoram, Silbermintz Ari, Zevit Noam, Shamir Raanan
Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center of Israel, Petah Tikva Sackler Faculty of Medicine, Tel-Aviv University Department of Gastroenterology, Sheba Medical Center-Tel Hashomer, Tel Aviv Department of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel.
J Pediatr Gastroenterol Nutr. 2017 Oct;65(4):410-415. doi: 10.1097/MPG.0000000000001545.
Data describing the incidence and risk factors for colectomy in pediatric ulcerative colitis (UC) is inconsistent. Our aim was to describe the colectomy rate and to identify risk factors associated with colectomy in a large cohort of children with UC with long-term follow-up.
We performed a retrospective chart review of pediatric UC cases that were diagnosed at Schneider Children's Medical Center of Israel between 1981 and 2013. Potential predictors for colectomy including age at diagnosis, sex, disease extent, severity indices, and different therapeutic regimens during disease course were assessed.
Of 188 patients with pediatric onset UC, 34 (18%) underwent colectomy. Median follow-up was 6.9 years (range, 1-30). Kaplan-Meier survival estimates of the cumulative probability for colectomy were 4% at 1 year and 17% at 10 years from diagnosis. Multivariate Cox models showed that male sex (hazard ratio 4.2, P = 0.001) and severe disease at diagnosis reflected by Pediatric Ulcerative Colitis Activity Index score ≥65 (hazard ratio 8.9, P < 0.001) were associated with increased risk for colectomy. Age, disease extent, ethnicity, family history of inflammatory bowel disease, early introduction of immunomodulators, or treatment with antitumor necrosis factor α agent did not affect the risk of colectomy.
Male sex and higher Pediatric Ulcerative Colitis Activity Index score at diagnosis are independent risk factors for colectomy.
描述儿童溃疡性结肠炎（UC）结肠切除术发病率及风险因素的数据并不一致。我们的目的是描述结肠切除术的发生率，并在一大群接受长期随访的儿童UC患者中确定与结肠切除术相关的风险因素。
我们对1981年至2013年期间在以色列施耐德儿童医学中心诊断的儿童UC病例进行了回顾性病历审查。评估了结肠切除术的潜在预测因素，包括诊断时的年龄、性别、疾病范围、严重程度指数以及疾病过程中的不同治疗方案。
188例儿童期发病的UC患者中，34例（18%）接受了结肠切除术。中位随访时间为6.9年（范围1 - 30年）。从诊断开始，结肠切除术累积概率的Kaplan - Meier生存估计在1年时为4%，10年时为17%。多变量Cox模型显示，男性（风险比4.2，P = 0.001）以及儿童溃疡性结肠炎活动指数评分≥65所反映的诊断时的严重疾病（风险比8.9，P < 0.001）与结肠切除术风险增加相关。年龄、疾病范围、种族、炎症性肠病家族史、早期引入免疫调节剂或使用抗肿瘤坏死因子α药物治疗均不影响结肠切除术风险。
男性以及诊断时较高的儿童溃疡性结肠炎活动指数评分是结肠切除术的独立风险因素。
