Song Eun Mi, Kim Nayoung, Lee Sun-Ho, Chang Kiju, Hwang Sung Wook, Park Sang Hyoung, Yang Dong-Hoon, Byeon Jeong-Sik, Myung Seung-Jae, Yang Suk-Kyun, Ye Byong Duk
a Department of Gastroenterology , University of Ulsan College of Medicine, Asan Medical Center , Seoul , South Korea.
b Department of Clinical Epidemiology and Biostatistics , University of Ulsan College of Medicine, Asan Medical Center , Seoul , South Korea.
Scand J Gastroenterol. 2018 Apr;53(4):417-425. doi: 10.1080/00365521.2018.1437927. Epub 2018 Feb 19.
This study aimed to evaluate the clinical characteristics and clinical course of Asian elderly-onset Crohn's disease (EOCD) patients in a large well-defined cohort of South Korean IBD patients.
From the Asan inflammatory bowel disease registry, we identified 29 EOCD patients (diagnosed with CD in age of 60 years or over) out of 2989 CD patients (1.0%). After excluding two patients with unclear data, 27 EOCD were matched with 108 young-onset CD (YOCD) and 108 middle age-onset CD (MOCD) for the interval from symptom onset to diagnosis (±3 years) and follow-up duration (±3 years).
Females were predominant in the EOCD group (59.3%) compared to MOCD (31.5%) and YOCD (29.6%) groups (p = .012). In EOCD group, terminal ileal location was the most common (63.0%) at diagnosis, whereas ileocolonic location in other groups (57.4% in MOCD and 78.7% in YOCD, respectively) (p < .001). Patients with perianal fistula at CD diagnosis were less common (14.8% in EOCD vs. 28.7% in MOCD vs. 49.1% in YOCD, p < .001). During follow-up, thiopurines were used less frequently in the EOCD group (48.1% in EOCD vs. 87.0% in MOCD vs. 89.8% in YOCD, p < .001), but the risk for intestinal resection was comparable among three groups (p = .583).
EOCD may have a better clinical course than MOCD and YOCD, as demonstrated by the similar risk for intestinal resection despite the less frequent use of thiopurines.
本研究旨在评估在一大群明确界定的韩国炎症性肠病（IBD）患者中，亚洲老年起病的克罗恩病（EOCD）患者的临床特征和临床病程。
从峨山炎症性肠病登记处，我们在2989例克罗恩病（CD）患者中确定了29例EOCD患者（60岁及以上诊断为CD）（占1.0%）。排除两名数据不明确的患者后，27例EOCD患者与108例年轻起病的CD（YOCD）患者和108例中年起病的CD（MOCD）患者在症状出现至诊断的间隔时间（±3年）和随访时间（±3年）方面进行匹配。
与MOCD组（31.5%）和YOCD组（29.6%）相比，EOCD组女性占主导（59.3%）（p = 0.012）。在EOCD组中，诊断时末端回肠部位最常见（63.0%），而其他组中回结肠部位最常见（MOCD组为57.4%，YOCD组为78.7%）（p < 0.001）。CD诊断时伴有肛周瘘管的患者较少见（EOCD组为14.8%，MOCD组为28.7%，YOCD组为49.1%，p < 0.001）。在随访期间，EOCD组硫唑嘌呤的使用频率较低（EOCD组为48.1%，MOCD组为87.0%，YOCD组为89.8%，p < 0.001），但三组肠道切除的风险相当（p = 0.583）。
尽管硫唑嘌呤的使用频率较低，但肠道切除风险相似，这表明EOCD的临床病程可能比MOCD和YOCD更好。
