非裔美国人和白种人克罗恩病患者术后复发风险的比较。
A comparison of the risk of postoperative recurrence between African-American and Caucasian patients with Crohn's disease.
机构信息
Inflammatory Bowel Disease Center, University of Chicago Medicine, Chicago, Illinois.
出版信息
Aliment Pharmacol Ther. 2018 Nov;48(9):933-940. doi: 10.1111/apt.14951. Epub 2018 Aug 20.
BACKGROUND
Many patients with Crohn's disease will develop complications that require surgery. Recurrence after surgery is common.
AIM
To assess racial differences in postoperative recurrence between African-Americans and Caucasians.
METHODS
Medical records of Crohn's disease patients who underwent surgery (ileal, colonic, or ileocolonic resection) between June 2014 and June 2016 were reviewed. The primary endpoints were clinical and endoscopic remission at 6-12 months after a Crohn's disease surgery. Secondary outcomes included biological and histologic remission. Risks of recurrence were assessed by univariate, multivariate, and propensity score-matched analysis.
RESULTS
Thirty-six African-American and 167 Caucasian patients with Crohn's disease were included for analysis. There was no difference in disease location, disease behaviour, type of surgery performed, and pre- or postoperative medication use between the two groups. The rate of endoscopic remission did not differ between African-American and Caucasian patients (50% vs 42%, P = 0.76), and race did not influence the risk of endoscopic recurrence on univariate, multivariate, or propensity score-matched analysis. The rate of clinical remission was significantly lower in African-American patients compared to Caucasian patients (36% vs. 63%, P = 0.008). African-American race was significantly associated with clinical recurrence on univariate (odds ratio (OR) 6.76, 95% CI 1.50-30.40; P = 0.01), multivariate (OR 5.02, 95% CI 1.60-15.80; P = 0.006), and propensity-matched analysis (68% vs. 32% in Caucasians, P = 0.005). Rates of biologic and histologic remission were similar between the two groups on all analyses.
CONCLUSIONS
We found that African-American patients with Crohn's disease have a similar degree of objective measures of mucosal inflammation after surgery including endoscopic recurrence as compared to Caucasian patients. However, African-American race was significantly associated with clinical recurrence, suggesting the presence of ethnic variation in postoperative presentation in Crohn's disease.
背景
许多克罗恩病患者会出现需要手术的并发症。手术后复发很常见。
目的
评估非裔美国人和白种人之间术后复发的种族差异。
方法
回顾了 2014 年 6 月至 2016 年 6 月期间接受克罗恩病手术（回肠、结肠或回结肠切除术）的克罗恩病患者的病历。主要终点是克罗恩病手术后 6-12 个月的临床和内镜缓解。次要结果包括生物学和组织学缓解。通过单变量、多变量和倾向评分匹配分析评估复发风险。
结果
纳入 36 名非裔美国人和 167 名白种人克罗恩病患者进行分析。两组间疾病部位、疾病行为、手术类型和术前或术后用药无差异。内镜缓解率在非裔美国人和白种人患者之间无差异（50% vs 42%，P=0.76），种族在单变量、多变量或倾向评分匹配分析中均不影响内镜复发的风险。非裔美国患者的临床缓解率明显低于白种人患者（36% vs. 63%，P=0.008）。非裔美国种族在单变量（优势比（OR）6.76，95%可信区间 1.50-30.40；P=0.01）、多变量（OR 5.02，95%可信区间 1.60-15.80；P=0.006）和倾向评分匹配分析中与临床复发显著相关（白人患者中 68% vs. 32%，P=0.005）。两组在所有分析中生物和组织学缓解率相似。
结论
我们发现，与白人患者相比，克罗恩病非裔美国患者术后黏膜炎症的客观指标（包括内镜复发）程度相似。然而，非裔美国种族与临床复发显著相关，表明克罗恩病术后表现存在种族差异。
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