Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
Department of Gastroenterology, Sackler School of Medicine, Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel.
J Gastroenterol Hepatol. 2018 Mar;33(3):664-670. doi: 10.1111/jgh.14000.
Whether an early use of azathioprine (AZA) can alter the natural history of Crohn's disease (CD) remains debated. The aim of this study is to evaluate the impact of AZA on disease progression in a cohort of patients with early CD.
This longitudinal cohort study examined patients with early CD defined as disease duration ≤ 18 months and no previous use of disease-modifying agents according to Paris definition. The primary outcome was the proportion of CD-related intestinal surgery. Cox regression analysis was performed to identify potential predictive factors of CD progression.
One-hundred and ninety patients with early CD were enrolled in the study. After a median follow-up of 57 months (interquartile range, 31.3-76.2), 31 patients underwent abdominal surgeries, 48 patients were hospitalized, and 68 patients experienced clinical flares. The cumulative rate of remaining free of CD-related bowel surgery, hospitalization, and flare at 5 years on AZA treatment was 0.65, 0.59, and 0.39, respectively. Three independent predictors of CD-related operations were identified: prior bowel resection (hazard ratio [HR], 9.23; 95% confidence interval [CI] 3.67-23.23), smoker (HR, 4.0; 95% CI 1.38-11.65), and hemoglobin < 110 g/L at the time of initiation of AZA (HR, 4.36; 95% CI 1.80-10.58). Conversely, AZA treatment duration > 36 months (HR, 0.04; 95% CI 0.01-0.15) was associated with reduced CD-related operations.
Prior bowel resection, smoking, and hemoglobin < 110 g/L at the time of initiation of AZA were risk factors associated with intestinal surgery in patients with early CD. However, prolonged use (≥ 36 months) of AZA was associated with a more favorable disease course of early CD.
是否早期使用巯嘌呤（AZA）可以改变克罗恩病（CD）的自然病程仍存在争议。本研究旨在评估 AZA 对早期 CD 患者疾病进展的影响。
本纵向队列研究纳入了根据巴黎定义定义的疾病持续时间≤18 个月且无既往使用疾病修饰剂的早期 CD 患者。主要结局是 CD 相关肠手术的比例。采用 Cox 回归分析确定 CD 进展的潜在预测因素。
本研究纳入了 190 例早期 CD 患者。中位随访 57 个月（四分位距，31.3-76.2）后，31 例患者接受了腹部手术，48 例患者住院，68 例患者出现临床发作。5 年时继续无 AZA 治疗相关 CD 肠手术、住院和发作的累积率分别为 0.65、0.59 和 0.39。确定了 CD 相关手术的三个独立预测因素：既往肠切除术（危险比 [HR]，9.23；95%置信区间 [CI]，3.67-23.23）、吸烟者（HR，4.0；95% CI，1.38-11.65）和 AZA 起始时血红蛋白<110 g/L（HR，4.36；95% CI，1.80-10.58）。相反，AZA 治疗时间>36 个月（HR，0.04；95% CI，0.01-0.15）与 CD 相关手术减少相关。
AZA 治疗早期 CD 时，起始时存在既往肠切除术、吸烟和血红蛋白<110 g/L 是与肠手术相关的危险因素。然而，延长 AZA 治疗时间（≥36 个月）与早期 CD 的疾病过程更有利相关。
