Department of Medicine and Therapeutics, Institute of Digestive Disease, State Key Laboratory of Digestive Disease, LKS Institute of Health Science, The Chinese University of Hong Kong, Hong Kong.
Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong.
J Crohns Colitis. 2018 Nov 28;12(12):1392-1398. doi: 10.1093/ecco-jcc/jjy120.
The presence of perianal fistulas in Crohn's disease [CD] denotes increased disease aggressiveness. We studied the epidemiology and clinical outcomes of perianal CD [PCD] using the Hong Kong territory-wide IBD Registry [HKIBDR].
Consecutive patients with PCD were identified from the HKIBDR, and disease characteristics, treatments, and outcomes were analysed. The risks for medical and surgical therapies were assessed using Kaplan-Meier analysis.
Among 981 patients with CD with 10530 patient-years of follow-up, 283 [28.8%] had perianal involvement, of which 120 [42.4%] were as first presentation. The mean age at diagnosis of PCD was 29.1 years, and 78.8% were male. The median follow-up duration was 106 months (interquartile range [IQR]: 65-161 months]. Perianal fistula [84.8%] and perianal abscess [52.7%] were the two commonest forms. Male, younger age at diagnosis of CD, and penetrating phenotypes were associated with development of PCD in multivariate analysis. Of 242 patients with fistulizing PCD, 70 [29.2%] required ≥5 courses of antibiotics, and 98 [40.5%] had ≥2 surgical procedures. Nine patients required defunctioning surgery and 4 required proctectomy. Eighty-four patients [34.7%] received biologics. Cumulative probabilities for use of biologics were 4.7%, 5.8%, and 8.6% at 12 months, 36 months, and 96 months, respectively, while the probabilities for surgery were 67.2%, 71.6%, and 77.7%, respectively. Five mortalities were recorded, including 2 cases of anal cancer, 2 CD-related complications, and one case of pneumonia.
Over 40% of CD patients presented with perianal disease at diagnosis. Patients with PCD had poor outcome, with young age of onset, multiple antibiotic use, and repeated surgery.
克罗恩病（CD）患者出现肛周瘘管表示疾病侵袭性增强。我们利用香港全港炎症性肠病注册处（HKIBDR）研究了 CD 患者的肛周疾病（PCD）的流行病学和临床结局。
从 HKIBDR 中确定了连续的 PCD 患者，并分析了疾病特征、治疗和结局。使用 Kaplan-Meier 分析评估了药物和手术治疗的风险。
在 981 名 CD 患者中，有 10530 患者年的随访记录，其中 283 名（28.8%）有肛周受累，其中 120 名（42.4%）为首发症状。PCD 的诊断年龄中位数为 29.1 岁，78.8%为男性。中位随访时间为 106 个月（四分位距[IQR]：65-161 个月）。肛周瘘管（84.8%）和肛周脓肿（52.7%）是最常见的两种形式。多变量分析显示，男性、CD 诊断时年龄较小以及穿透表型与 PCD 的发展相关。在 242 名瘘管性 PCD 患者中，70 名（29.2%）需要≥5 疗程抗生素，98 名（40.5%）需要≥2 次手术。9 名患者需要进行结肠造口术，4 名患者需要进行直肠切除术。84 名患者（34.7%）接受了生物制剂治疗。12 个月、36 个月和 96 个月时，使用生物制剂的累积概率分别为 4.7%、5.8%和 8.6%，而手术的概率分别为 67.2%、71.6%和 77.7%。记录了 5 例死亡，包括 2 例肛门癌、2 例 CD 相关并发症和 1 例肺炎。
超过 40%的 CD 患者在诊断时就出现肛周疾病。PCD 患者的结局较差，其发病年龄较小，需要多次使用抗生素和反复手术。
