肛周病变对克罗恩病患者 10 年临床转归的影响
Effects of Perianal Involvement on Clinical Outcomes in Crohn's Disease over 10 Years.
机构信息
Department of Medicine, Graduate School, Kyung Hee University, Seoul, Korea.
Department of Internal Medicine and Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea.
出版信息
Gut Liver. 2018 May 15;12(3):297-305. doi: 10.5009/gnl17275.
BACKGROUND/AIMS: There was the assumption that Crohn's disease (CD) patients with perianal lesions might have different clinical courses compared to those without. However, quantifiable data comparing the long-term outcomes between the two groups are scarce.
METHODS
We retrospectively reviewed 221 consecutive patients newly diagnosed with CD and registered at the IBD clinic of Severance Hospital, in Seoul, Korea, between January 1990 and October 2005. We compared patients with perianal CD (PCD) and non-perianal CD (NPCD) in terms of clinical outcomes over 10 years.
RESULTS
PCD progressed more frequently from inflammatory to complicated behavior than NPCD. Moreover, corticosteroids were prescribed in 102 patients with PCD and only 57 with NPCD (82.9% vs 58.2%, p＜0.001), immunosuppressants in 89 and 42 (72.4% vs 42.9%, p＜0.001), and anti-tumor necrosis factor α (TNF-α) in 37 and 12 (30.1% vs 12.2%, p=0.002). Cumulative hospitalization rates were 82.1% in PCD and 72.4% in NPCD (p=0.086), and surgical intervention rates were 39.8% and 51.0%, respectively (p=0.097).
CONCLUSIONS
Patients with PCD were more likely than those with NPCD to be administered corticosteroids, immunosuppressants, and anti-TNF-α. However, there is no significant difference in the cumulative rates of surgical interventions or hospitalizations.
背景/目的：人们假设，患有肛周病变的克罗恩病（CD）患者可能与无肛周病变的患者相比具有不同的临床病程。然而，关于两组患者之间长期结局的可量化数据却很少。
方法
我们回顾性分析了 1990 年 1 月至 2005 年 10 月期间在韩国首尔 Severance 医院的 IBD 诊所新诊断为 CD 的 221 例连续患者。我们比较了肛周 CD（PCD）和非肛周 CD（NPCD）患者在 10 年内的临床结局。
结果
PCD 从炎症性向复杂性行为的进展比 NPCD 更为频繁。此外，在 102 例 PCD 患者中使用了皮质类固醇，而在 57 例 NPCD 患者中仅使用了皮质类固醇（82.9%比 58.2%，p＜0.001），在 89 例 PCD 患者中使用了免疫抑制剂，而在 42 例 NPCD 患者中仅使用了免疫抑制剂（72.4%比 42.9%，p＜0.001），在 37 例 PCD 患者中使用了抗肿瘤坏死因子-α（TNF-α），而在 12 例 NPCD 患者中仅使用了抗 TNF-α（30.1%比 12.2%，p=0.002）。PCD 的累积住院率为 82.1%，NPCD 为 72.4%（p=0.086），手术干预率分别为 39.8%和 51.0%（p=0.097）。
结论
与 NPCD 患者相比，PCD 患者更有可能接受皮质类固醇、免疫抑制剂和抗 TNF-α治疗。然而，手术干预或住院的累积率没有显著差异。
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