Song Eun Mi, Lee Ho-Su, Kim Ye-Jee, Oh Eun Hye, Ham Nam Seok, Kim Jeongseok, Hwang Sung Wook, Park Sang Hyoung, Yang Dong-Hoon, Ye Byong Duk, Byeon Jeong-Sik, Myung Seung-Jae, Lee Jong Lyul, Yoon Yong Sik, Yu Chang Sik, Yang Suk-Kyun
Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea.
Department of Biochemistry, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea.
Dig Dis Sci. 2020 Apr;65(4):1189-1196. doi: 10.1007/s10620-019-05819-9. Epub 2019 Sep 4.
Little is known about the natural history of perianal fistulas in Asian populations with Crohn's disease (CD).
We investigated the incidence and outcomes of perianal CD (pCD) in Korean CD patients.
A nationwide population-based cohort of 6265 CD patients diagnosed in 2010-2014 was analyzed to investigate the incidence and outcomes of pCD. The results were validated in a hospital-based cohort of 2923 CD patients diagnosed in 1981-2015. Factors associated with pCD development were analyzed. The incidence and outcomes of pCD were compared between the prebiologic and biologic eras.
pCD occurred in 39.2% of the population-based cohort and 56.1% of the hospital-based cohort during the median follow-up of 4.2 and 8.5 years, respectively. The cumulative incidence of pCD was 40.0% at 5 years after CD diagnosis in the population-based cohort and 62.5% at 20 years in the hospital-based cohort. In multivariate analysis, pCD development was positively associated with male sex, younger age and colonic involvement at diagnosis, early diagnosis, and CD diagnosis in the prebiologic era. The cumulative probability of proctectomy at 10, 20, and 30 years after pCD diagnosis was 2.9%, 12.2%, and 16.2%, respectively. The cumulative incidence of pCD occurring after CD diagnosis and the cumulative probability of proctectomy were significantly lower in the biologic era than in the prebiologic era (p < 0.001 and p = 0.03, respectively).
Compared with Western patients with CD, Korean patients show a high incidence of pCD but have a low probability of proctectomy, suggesting the favorable course of pCD.
关于亚洲克罗恩病（CD）患者肛周瘘管的自然病史，我们所知甚少。
我们调查了韩国CD患者中肛周CD（pCD）的发病率和结局。
分析了2010 - 2014年确诊的6265例CD患者的全国性基于人群的队列，以研究pCD的发病率和结局。结果在1981 - 2015年确诊的2923例CD患者的基于医院的队列中得到验证。分析了与pCD发生相关的因素。比较了生物制剂时代之前和生物制剂时代pCD的发病率和结局。
在基于人群的队列中，中位随访4.2年期间，39.2%的患者发生了pCD；在基于医院的队列中，中位随访8.5年期间，56.1%的患者发生了pCD。在基于人群的队列中，CD诊断后5年pCD的累积发病率为40.0%；在基于医院的队列中，CD诊断后20年pCD的累积发病率为62.5%。多因素分析显示，pCD的发生与男性、年轻、诊断时结肠受累、早期诊断以及生物制剂时代之前的CD诊断呈正相关。pCD诊断后10年、20年和30年直肠切除术的累积概率分别为2.9%、12.2%和16.2%。生物制剂时代CD诊断后发生pCD的累积发病率和直肠切除术的累积概率显著低于生物制剂时代之前（分别为p < 0.001和p = 0.03）。
与西方CD患者相比，韩国患者pCD发病率高，但直肠切除术概率低，提示pCD病程良好。
