Oh Kyunghwan, Oh Eun Hye, Baek Seunghee, Song Eun Mi, Kim Gwang-Un, Seo Myeongsook, Hwang Sung Wook, Park Sang Hyoung, Yang Dong-Hoon, Kim Kyung-Jo, Byeon Jeong-Sik, Myung Seung-Jae, Yang Suk-Kyun, Ye Byong Duk
Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
PLoS One. 2017 Jun 16;12(6):e0179266. doi: 10.1371/journal.pone.0179266. eCollection 2017.
Intestinal inflammation and mucosal damage in Crohn's disease (CD) are believed to progress even during clinical remission. We investigated the long-term prognosis of CD patients in clinical remission according to serum C-reactive protein (CRP) levels. This study included 339 CD patients in clinical remission (Crohn's disease activity index < 150) for more than 6 months between January 2008 and December 2010. Clinical outcomes were compared between patients with normal and elevated CRP levels during clinical remission. During clinical remission, 150 patients had normal CRP consistently and 189 had elevated CRP at least once. During follow-up (median, 7.9 years [interquartile range, 6.8-8.0]), the Kaplan-Meier analysis with the log-rank test showed that normal CRP group had a longer CD-related hospitalization-free survival (P = 0.007) and a longer CD-related intestinal resection-free survival (P = 0.046) than elevated CRP group. In multivariate analysis, elevated CRP was significantly and independently associated with an increased risk of subsequent CD-related hospitalization (adjusted hazard ratio [aHR] 1.787, 95% confidence interval [CI]: 1.245-2.565, P = 0.002) and of subsequent CD-related intestinal resection (aHR 1.726, 95% CI: 1.003-2.969, P = 0.049). The most common reason for CD-related hospitalization was penetrating complications (35.6%). Even when CD patients are in clinical remission, elevated CRP is significantly associated with subsequent CD-related hospitalization and CD-related intestinal resection during follow-up. CD patients in clinical remission but elevated CRP should receive more careful attention and timely interventions to improve long-term outcomes.
克罗恩病（CD）患者即使在临床缓解期，肠道炎症和黏膜损伤仍被认为会持续进展。我们根据血清C反应蛋白（CRP）水平对临床缓解期的CD患者进行了长期预后调查。本研究纳入了2008年1月至2010年12月期间临床缓解（克罗恩病活动指数<150）超过6个月的339例CD患者。比较了临床缓解期CRP水平正常和升高的患者的临床结局。临床缓解期，150例患者CRP持续正常，189例患者至少有一次CRP升高。在随访期间（中位数为7.9年[四分位间距为6.8 - 8.0年]），采用对数秩检验的Kaplan-Meier分析显示，CRP正常组的无CD相关住院生存期更长（P = 0.007），无CD相关肠道切除生存期也比CRP升高组更长（P = 0.046）。多因素分析显示，CRP升高与随后发生CD相关住院的风险显著且独立相关（校正风险比[aHR] 1.787，95%置信区间[CI]：1.245 - 2.565，P = 0.002），以及与随后发生CD相关肠道切除的风险相关（aHR 1.726，95% CI：1.003 - 2.969，P = 0.049）。CD相关住院最常见的原因是穿透性并发症（35.6%）。即使CD患者处于临床缓解期，CRP升高仍与随访期间随后发生的CD相关住院和CD相关肠道切除显著相关。临床缓解但CRP升高的CD患者应受到更密切的关注并及时进行干预，以改善长期预后。
