Everhov Åsa H, Sachs Michael C, Malmborg Petter, Nordenvall Caroline, Myrelid Pär, Khalili Hamed, Elmberg Maria, Ekbom Anders, Askling Johan, Jakobsson Gustav, Halfvarson Jonas, Ludvigsson Jonas F, Olén Ola
a Department of Clinical Science and Education , Södersjukhuset, Karolinska Institutet , Stockholm , Sweden.
b Clinical Epidemiology Unit, Department of Medicine Solna , Karolinska Institutet , Stockholm , Sweden.
Scand J Gastroenterol. 2019 Jan;54(1):55-63. doi: 10.1080/00365521.2018.1564361. Epub 2019 Jan 31.
To investigate inflammatory bowel disease (IBD) register-based subtype classifications over a patient's disease course and over time.
We examined International Classification of Diseases coding in patients with ≥2 IBD diagnostic listings in the National Patient Register 2002-2014 (n = 44,302).
18% of the patients changed diagnosis (17% of adults, 29% of children) during a median follow-up of 3.8 years. Of visits with diagnoses of Crohn's disease (CD) or ulcerative colitis (UC), 97% were followed by the same diagnosis, whereas 67% of visits with diagnosis IBD-unclassified (IBD-U) were followed by another IBD-U diagnosis. Patients with any diagnostic change changed mostly once (47%) or twice (31%), 39% from UC to CD, 33% from CD to UC and 30% to or from IBD-U. Using a classification algorithm based on the first two diagnoses ('incident classification'), suited for prospective cohort studies, the proportion adult patients with CD, UC, and IBD-U 2002-2014 were 29%, 62%, and 10% (43%, 45%, and 12% in children). A classification model incorporating additional information from surgeries and giving weight to the last 5 years of visits ('prevalent classification'), suited for description of a study population at end of follow-up, classified 31% of adult cases as CD, 58% as UC and 11% as IBD-U (44%, 38%, and 18% in children).
IBD subtype changed in 18% during follow-up. The proportion with CD increased and UC decreased from definition at start to end of follow-up. IBD-U was more common in children.
研究基于炎症性肠病（IBD）登记的患者疾病进程及随时间变化的亚型分类。
我们检查了2002 - 2014年国家患者登记中诊断清单≥2次的IBD患者的国际疾病分类编码（n = 44,302）。
在中位随访3.8年期间，18%的患者改变了诊断（成人患者为17%，儿童患者为29%）。在诊断为克罗恩病（CD）或溃疡性结肠炎（UC）的就诊中，97%随后为相同诊断，而诊断为未分类IBD（IBD - U）的就诊中，67%随后为另一种IBD - U诊断。有任何诊断变化的患者大多改变一次（47%）或两次（31%），39%从UC变为CD，33%从CD变为UC，30%变为IBD - U或从IBD - U变来。使用基于前两次诊断的分类算法（“发病分类”），适用于前瞻性队列研究，2002 - 2014年成人CD、UC和IBD - U患者比例分别为29%、62%和10%（儿童分别为43%、45%和12%）。一个纳入手术额外信息并对最后5年就诊加权的分类模型（“现患分类”），适用于随访结束时研究人群的描述，将31%的成人病例分类为CD，58%为UC，11%为IBD - U（儿童分别为44%、38%和18%）。
随访期间18%的IBD亚型发生改变。从随访开始到结束，CD比例增加，UC比例下降。IBD - U在儿童中更常见。
