基于人群队列的肛周瘘管型克罗恩病的流行病学及转归的时间趋势

Time trends in the epidemiology and outcome of perianal fistulizing Crohn's disease in a population-based cohort.

作者信息

Göttgens Kevin W A, Jeuring Steven F G, Sturkenboom Rosel, Romberg-Camps Mariëlle J L, Oostenbrug Liekele E, Jonkers Daisy M A E, Stassen Laurents P S, Masclee Ad A M, Pierik Marieke J, Breukink Stéphanie O

机构信息

Departments of aGeneral Surgery bInternal Medicine, Division of Gastroenterology-Hepatology cSchool of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Centre, Maastricht dDepartment of Internal Medicine and Gastroenterology-Hepatology, Zuyderland Medical Centre, Sittard-Geleen eDepartment of Internal Medicine and Gastroenterology-Hepatology, Zuyderland Medical Centre, Heerlen, The Netherlands.

出版信息

Eur J Gastroenterol Hepatol. 2017 May;29(5):595-601. doi: 10.1097/MEG.0000000000000840.

DOI:10.1097/MEG.0000000000000840

PMID:28350751

Abstract

OBJECTIVE

Perianal disease is a debilitating condition that frequently occurs in Crohn's disease (CD) patients. It is currently unknown whether its incidence has changed in the era of frequent immunomodulator use and biological availability. We studied the incidence and outcome of perianal and rectovaginal fistulas over the past two decades in our population-based Inflammatory Bowel Disease South-Limburg cohort.

PATIENTS AND METHODS

All 1162 CD patients registered in the Inflammatory Bowel Disease South-Limburg registry were included. The cumulative probabilities of developing a perianal and rectovaginal fistula were compared between three eras distinguished by the year of CD diagnosis: 1991-1998, 1999-2005 and 2006-2011. Second, clinical risk factors and the risk of fistula recurrence were determined.

RESULTS

The cumulative 5-year perianal fistula rate was 14.1% in the 1991-1998 era, 10.4% in the 1999-2005 era and 10.3% in the 2006-2011 era, P=0.70. Colonic disease was associated with an increased risk of developing perianal disease, whereas older age was associated with a decreased risk (both P<0.01). Over time, more patients were exposed to immunomodulators or biologicals before fistula diagnosis (18.5 vs. 32.1 vs. 52.1%, respectively, P=0.02) and started biological therapy thereafter (18.6 vs. 34.1 vs. 54.0%, respectively, P<0.01). The cumulative 5-year perianal fistula recurrence rate was not significantly different between eras (19.5 vs. 25.5 vs. 33.1%, P=0.28). In contrast, the cumulative 5-year rectovaginal rate attenuated from 5.7% (the 1991-2005 era) to 1.7% (the 2006-2011 era), P=0.01.

CONCLUSION

Over the past two decades, the risk of developing a perianal fistula was stable, as well as its recurrence rate, underlining the lasting need for improving treatment strategies for this invalidating condition.

摘要

目的

肛周疾病是一种使人衰弱的病症，在克罗恩病（CD）患者中经常出现。在频繁使用免疫调节剂和生物制剂的时代，其发病率是否发生变化目前尚不清楚。我们在基于人群的南林堡炎症性肠病队列中研究了过去二十年肛周和直肠阴道瘘的发病率及转归情况。

患者与方法

纳入了在南林堡炎症性肠病登记处登记的所有1162例CD患者。根据CD诊断年份区分的三个时代，比较发生肛周和直肠阴道瘘的累积概率：1991 - 1998年、1999 - 2005年和2006 - 2011年。其次，确定临床危险因素及瘘复发风险。

结果

1991 - 1998年时代5年肛周瘘累积发生率为14.1%，1999 - 2005年时代为10.4%，2006 - 2011年时代为10.3%，P = 0.70。结肠疾病与发生肛周疾病风险增加相关，而年龄较大则与风险降低相关（均P < 0.01）。随着时间推移，更多患者在瘘诊断前接受了免疫调节剂或生物制剂治疗（分别为18.5%对32.1%对52.1%，P = 0.02），且此后开始生物治疗（分别为18.6%对34.1%对54.0%，P < 0.01）。各时代间5年肛周瘘累积复发率无显著差异（19.5%对25.5%对33.1%，P = 0.28）。相比之下，5年直肠阴道瘘累积发生率从5.7%（1991 - 2005年时代）降至1.7%（2006 - 2011年时代），P = 0.01。