Division of Gastroenterology, Department of Internal Medicine, Kawasaki Medical School, Okayama, Japan.
Digestion. 2017;96(3):158-165. doi: 10.1159/000480078. Epub 2017 Sep 1.
BACKGROUND/AIMS: We aimed to evaluate the prognostic factors that can aid in the prevention of first and second surgeries in patients with Crohn's disease (CD).
The clinical records of 115 patients with CD whose disease onset was between January 1987 and July 2012 were retrospectively investigated. The cumulative rate of bowel resection for CD-related intestinal manifestations following onset until the first surgery and the cumulative rate of reoperation following the first to second surgeries were estimated using the Kaplan-Meier method, and the relationship to each factor was statistically analyzed using the log-rank test. The background factors that influenced the cumulative rate of the first surgery and reoperation were evaluated using univariate and multivariate analyses.
The cumulative bowel resection rate was significantly higher in patients with ileocolitis-type CD (p = 0.0018) and in those with CD with smoking habits (p = 0.0315). And the cumulative reoperation rate was significantly higher in patients with ileocolitis-type CD (p = 0.0161) and those without early intervention with infliximab (p = 0.0161).
Ileocolitis-type CD and smoking habit might be initiating factors for bowel resection due to CD-related intestinal manifestations. Early intervention with infliximab likely prevents reoperation for CD recurrence.
背景/目的：我们旨在评估有助于预防克罗恩病（CD）患者首次和再次手术的预后因素。
回顾性调查了 1987 年 1 月至 2012 年 7 月期间发病的 115 例 CD 患者的临床记录。采用 Kaplan-Meier 法估计发病后 CD 相关肠道表现行肠切除术的累积率和首次手术后再次手术的累积率，并采用对数秩检验对各因素进行统计学分析。使用单变量和多变量分析评估影响首次手术和再次手术累积率的背景因素。
回肠结肠炎型 CD 患者（p=0.0018）和有吸烟习惯的 CD 患者（p=0.0315）的肠切除术累积率显著更高。回肠结肠炎型 CD 患者（p=0.0161）和未早期使用英夫利昔单抗干预的患者（p=0.0161）的再次手术累积率显著更高。
回肠结肠炎型 CD 和吸烟习惯可能是 CD 相关肠道表现导致肠切除术的起始因素。早期使用英夫利昔单抗可能预防 CD 复发的再次手术。
