基于人群队列的肛门周围克罗恩病瘘管自然病程的最新进展。
Update on the Natural Course of Fistulizing Perianal Crohn's Disease in a Population-Based Cohort.
机构信息
Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota.
Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
出版信息
Inflamm Bowel Dis. 2019 May 4;25(6):1054-1060. doi: 10.1093/ibd/izy329.
BACKGROUND
This study sought to re-estimate the cumulative incidence of perianal or rectovaginal fistulas and the associated proctectomy rate in the prebiologic era vs the biologic era using a population-based cohort of Crohn's disease (CD) patients.
METHODS
The medical records of 414 residents of Olmsted County, Minnesota, who were diagnosed with CD between 1970 and 2010 were reviewed. The cumulative incidence of perianal or rectovaginal fistulas from time of CD diagnosis and the cumulative rate of proctectomy from date of first perianal or rectovaginal fistula diagnosis were estimated using the Kaplan-Meier method.
RESULTS
Eighty-five patients (20.5%) diagnosed with CD between 1970 and 2010 had at least 1 perianal or rectovaginal fistula episode between January 1, 1970, and June 30, 2016. The cumulative incidence of perianal or rectovaginal fistulas was 18% after 10 years, 23% after 20 years, and 24% after 30-40 years from CD diagnosis. The cumulative incidence of perianal or rectovaginal fistulas was significantly lower in patients diagnosed in 1998 or after than in patients diagnosed before 1998 (P = 0.03, log-rank). Among 85 patients developing perianal or rectovaginal fistulas, 16 patients (18.8%) underwent proctectomy for the treatment of perianal or rectovaginal fistulas during follow-up.
CONCLUSIONS
In a population-based inception cohort of CD, one-fifth of patients were diagnosed with at least 1 perianal or rectovaginal fistula. The cumulative probability of perianal or rectovaginal fistulizing disease has decreased over time.
背景
本研究旨在使用克罗恩病（CD）患者的基于人群队列，重新估计生物制剂时代与生物制剂前时代的肛门或直肠阴道瘘的累积发生率和相关的直肠切除术率。
方法
回顾了明尼苏达州奥姆斯特德县 414 名居民的医疗记录，这些居民在 1970 年至 2010 年间被诊断为 CD。使用 Kaplan-Meier 方法估计从 CD 诊断时起肛门或直肠阴道瘘的累积发生率和从首次肛门或直肠阴道瘘诊断日期起的直肠切除术累积率。
结果
1970 年至 2010 年间被诊断为 CD 的 85 名患者在 1970 年 1 月 1 日至 2016 年 6 月 30 日期间至少有一次肛门或直肠阴道瘘发作。肛门或直肠阴道瘘的 10 年、20 年和 30-40 年累积发生率分别为 18%、23%和 24%。1998 年或之后诊断的患者的肛门或直肠阴道瘘的累积发生率明显低于 1998 年之前诊断的患者（P = 0.03，对数秩检验）。在 85 名发生肛门或直肠阴道瘘的患者中，16 名（18.8%）在随访期间因肛门或直肠阴道瘘而行直肠切除术。
结论
在基于人群的 CD 发病队列中，五分之一的患者被诊断出至少有一次肛门或直肠阴道瘘。肛门或直肠阴道瘘的累积概率随时间推移而降低。
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