诊断时的 Lémann 指数预测克罗恩病早期手术的风险。

Lémann Index at Diagnosis Predicts the Risk of Early Surgery in Crohn's Disease.

机构信息

Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China.

Inflammatory Bowel Disease Center, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China.

出版信息

Dis Colon Rectum. 2018 Feb;61(2):207-213. doi: 10.1097/DCR.0000000000000930.

DOI:10.1097/DCR.0000000000000930

PMID:29337776

Abstract

BACKGROUND

Identifying patients with Crohn's disease with rapid disease progress or high risk of early surgery is crucial to clinical decision making.

OBJECTIVE

The aim was to evaluate the correlation between the Lémann index at diagnosis and abdominal surgery in the first year after Crohn's disease diagnosis and to find the risk factors for early surgery.

DESIGN

This was a retrospective cohort study.

SETTINGS

The study was conducted at a single tertiary hospital.

PATIENTS

Patients diagnosed with Crohn's disease between 2013 and 2015 in our center were included.

MAIN OUTCOME MEASURES

The outcome of interest was the need for an abdominal surgery within 1 year after the Lémann index evaluation at diagnosis.

RESULTS

Of 212 eligible patients, 48 patients underwent abdominal surgery during follow-up. Lémann index was much higher in the surgery group (5.3 vs 2.6; p < 0.001). On tertiles of the Lémann index, the frequency of surgery grew (2.8%, 9.9%, and 55.7%; p < 0.001) as the Lémann index increased. The receiver operating characteristic curve was constructed taking into account the Lémann index for selecting patients with a high risk of surgery. Specificity, sensitivity, and area under receiver operating characteristic curve were 84.8%, 81.3%, and 0.89 of the Lémann Index at a cutoff level of 3.7. Patients with Lémann index ≥3.7 carried a higher risk of abdominal surgery (OR = 18.6; p < 0.001). Stricturing and penetrating disease were predictors for abdominal surgery, whereas antitumor necrosis factor treatment was associated with a significant reduction of surgical requirements.

LIMITATIONS

This study was limited by its retrospective design. The ability of the Lémann index to predict the long-term risk of surgery was unknown.

CONCLUSIONS

Lémann index at diagnosis is a reliable index to predict the risk of abdominal surgery in the first year after diagnosis of Crohn's disease. Patients with a high Lémann index might need closer follow-up or aggressive medical therapy. See Video Abstract at http://links.lww.com/DCR/A518.

摘要

背景

识别出具有快速疾病进展或早期手术高风险的克罗恩病患者对于临床决策至关重要。

目的

评估克罗恩病诊断时的勒曼指数与克罗恩病诊断后 1 年内腹部手术之间的相关性，并找出早期手术的危险因素。

设计

这是一项回顾性队列研究。

设置

该研究在一家三级医院进行。

患者

纳入 2013 年至 2015 年期间在我院诊断为克罗恩病的患者。

主要观察指标

感兴趣的结局是在诊断时评估勒曼指数后 1 年内是否需要进行腹部手术。

结果

在 212 名符合条件的患者中，48 名患者在随访期间接受了腹部手术。手术组的勒曼指数明显更高（5.3 比 2.6；p<0.001）。按勒曼指数的三分位数，手术频率随着勒曼指数的升高而增加（2.8%、9.9%和 55.7%；p<0.001）。考虑到勒曼指数，构建了接收者操作特征曲线，以选择手术风险高的患者。勒曼指数截断值为 3.7 时，特异性、敏感性和接收者操作特征曲线下面积分别为 84.8%、81.3%和 0.89。勒曼指数≥3.7 的患者腹部手术风险更高（OR=18.6；p<0.001）。狭窄和穿透性疾病是腹部手术的预测因素，而抗肿瘤坏死因子治疗与手术需求显著降低相关。