Gastroenterology Unit, Instituto de Investigación Sanitaria Princesa (IIS-IP) and CIBERehd, Hospital Universitario de La Princesa, Madrid, Spain.
Gastroenterology Unit and CIBERehd, Hospital Clinic de Barcelona, Barcelona, Spain.
Aliment Pharmacol Ther. 2019 Feb;49(4):419-428. doi: 10.1111/apt.15114. Epub 2019 Jan 13.
Cohort studies comparing the characteristics of childhood-onset and adulthood-onset inflammatory bowel disease (IBD) in the biologics era are scarce.
To compare disease characteristics, the use of immunomodulators and biologic agents and the need for surgery between childhood- and adulthood-onset IBD.
Inflammatory bowel disease patients from the ENEIDA registry diagnosed between 2007 and 2017 were included. The childhood-onset cohort comprised patients diagnosed at ≤16 years of age and the adulthood-onset cohort those diagnosed at >16 years. The cumulative incidences of immunosuppressive therapy, biologic therapy and surgery were estimated using Kaplan-Meier curves, compared by the log-rank test. Cox regression analysis was performed to identify potential predictive factors of treatment with immunosuppressants, biologic agents or surgery.
The adulthood-onset cohort comprised 21 200 patients out of 20 354 (96%) and the childhood-onset cohort 846 (4%). Median follow-up was 54 months in the childhood-onset cohort and 38 months in the adulthood-onset cohort (P < 0.01). Proportions of Crohn's disease, ileocolonic involvement and inflammatory behaviour at diagnosis were higher in the childhood-onset cohort. In the multivariate analysis, after adjusting for sex, type of IBD, extraintestinal manifestations, family history and smoking habit, childhood-onset IBD was associated with higher risk of immunomodulator use (hazard ratio [HR] = 1.2, 95% confidence interval [95% CI] = 1.1-1.2) and higher probability of receiving biologic treatment (HR = 1.2, 95% CI = 1.1-1.3). However, childhood-onset IBD was not associated with higher risk of surgery (HR = 0.9, 95% CI = 0.8-1.2).
Childhood-onset IBD has differential characteristics and higher risk of treatment with immunomodulators and biologic agents, compared with adulthood-onset IBD. Nevertheless, paediatric IBD is not associated with higher risk of surgery.
在生物制剂时代，比较儿童期和成年期发病的炎症性肠病（IBD）特征的队列研究很少。
比较儿童和成年发病的 IBD 之间的疾病特征、免疫调节剂和生物制剂的使用以及手术需求。
纳入了 2007 年至 2017 年期间在 ENEIDA 登记处诊断的 IBD 患者。儿童发病队列包括≤16 岁诊断的患者，成年发病队列包括>16 岁诊断的患者。使用 Kaplan-Meier 曲线估计免疫抑制治疗、生物治疗和手术的累积发生率，并通过对数秩检验进行比较。进行 Cox 回归分析以确定使用免疫抑制剂、生物制剂或手术治疗的潜在预测因素。
成年发病队列包括 21200 名患者（96%），儿童发病队列包括 846 名患者（4%）。儿童发病队列的中位随访时间为 54 个月，成年发病队列为 38 个月（P<0.01）。儿童发病队列的克罗恩病、回肠结肠受累和炎症行为的比例更高。在多变量分析中，在校正性别、IBD 类型、肠外表现、家族史和吸烟习惯后，儿童发病 IBD 与免疫调节剂使用的风险增加相关（风险比 [HR] = 1.2，95%置信区间 [95%CI] = 1.1-1.2）和接受生物治疗的可能性更高（HR = 1.2，95%CI = 1.1-1.3）。然而，儿童发病 IBD 与手术风险增加无关（HR = 0.9，95%CI = 0.8-1.2）。
与成年发病 IBD 相比，儿童发病 IBD 具有不同的特征，且更有可能接受免疫调节剂和生物制剂治疗。然而，儿科 IBD 与手术风险增加无关。
