University of Sheffield Medical School, Sheffield, UK.
Department of General Surgery, Northern General Hospital, Herries Road, Sheffield, S5 7AU, UK.
Tech Coloproctol. 2017 Jul;21(7):501-519. doi: 10.1007/s10151-017-1647-3. Epub 2017 Jun 20.
One in three patients with Crohn's disease will develop a perianal fistulae, and one third of these will achieve long-term healing or closure. A barrier to conducting well-designed clinical trials for these patients is a lack of understanding of prognostic factors. This systematic review sets out to identify factors associated with prognosis of perianal Crohn's fistulae.
This review was registered on the PROSPERO database (CRD42016050316) and conducted in line with PRISMA guidelines along a predefined protocol. English-language studies assessing baseline factors related to outcomes of fistulae treatment in adult patients were included. Searches were performed on MEDLINE and Embase databases. Screening of abstracts and full texts for eligibility was performed prior to extraction of data into predesigned forms. Bias was assessed using the QUIPS tool.
Searches identified 997 papers. Following removal of duplicates and secondary searches, 923 were screened for inclusion. Forty-seven papers were reviewed at full-text level and 13, 2 of which were randomised trials, were included in the final qualitative review. Two studies reported distribution of Crohn's disease as a prognostic factor for healing. Two studies found that CARD15 mutations decreased response of fistulae to antibiotics. Complexity of fistulae anatomy was implicated in prognosis by 4 studies.
This systematic review has identified potential prognostic markers, including genetic factors and disease behaviour. We cannot, however, draw robust conclusions from this heterogeneous group of studies; therefore, we recommend that a prospective cohort study of well-characterised patients with Crohn's perianal fistulae is undertaken.
三分之一的克罗恩病患者会出现肛周瘘，其中三分之一的患者会实现长期愈合或闭合。对这些患者进行精心设计的临床试验的一个障碍是对预后因素缺乏了解。本系统评价旨在确定与肛周克罗恩病瘘预后相关的因素。
本综述在 PROSPERO 数据库（CRD42016050316）上注册，并按照 PRISMA 指南以及预先制定的方案进行。纳入评估成人患者瘘管治疗结局相关基线因素的英语研究。在 MEDLINE 和 Embase 数据库中进行了检索。在将数据提取到预设计表格中之前，对摘要和全文进行了筛选，以确定是否符合纳入标准。使用 QUIPS 工具评估偏倚。
检索共确定了 997 篇论文。在去除重复项和二次检索后，对 923 篇进行了筛选以确定是否纳入。47 篇论文进行了全文审查，其中 13 篇、2 篇为随机试验，被纳入最终的定性综述。有两项研究报告了克罗恩病的分布是愈合的预后因素。有两项研究发现 CARD15 突变降低了瘘对抗生素的反应。四项研究表明瘘管解剖结构的复杂性与预后有关。
本系统评价确定了一些潜在的预后标志物，包括遗传因素和疾病行为。然而，我们不能从这组异质性研究中得出可靠的结论；因此，我们建议对具有明确特征的克罗恩病肛周瘘患者进行前瞻性队列研究。
