Aniwan Satimai, Limsrivilai Julajak, Pongprasobchai Supot, Pausawasdi Nonthalee, Prueksapanich Piyapan, Kongtub Natanong, Rerknimitr Rungsun
Division of Gastroenterology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand.
Intest Res. 2021 Apr;19(2):186-193. doi: 10.5217/ir.2020.00028. Epub 2020 Aug 18.
BACKGROUND/AIMS: The incidence of ulcerative colitis (UC) in Thailand (crude incidence rate of 0.28 per 100,000 persons) is much lower than in the West. The burden of UC varies in different populations. The aim of this study was to evaluate the natural history of UC over the two decades in Bangkok, Thailand.
This retrospective study included patients who were diagnosed with UC between 2000 and 2018 in 2 university hospitals. To evaluate changes in the disease course, we stratified patients into 2000-2009 cohort and 2010-2018 cohort. The cumulative probability of endoscopic healing, UC-related hospitalization and colectomy was estimated using the Kaplan-Meier method.
A total of 291 UC patients were followed for total of 2,228 person-years. Comparison between 2 cohorts, there were no differences in disease pattern and severity whereas an increase in the combination use of oral and topical mesalamine and the early use of thiopurine was observed. Only 1% of patients for each cohort required biologic agent at 5 years. The rate of achieving mucosal healing increased from 15% to 46% at 3 years (P< 0.01). The rate of UC-related hospitalization decreased from 30% to 21% at 5 years (P< 0.05). The rate of colectomy decreased from 6% to 2% at 5 years (P< 0.05).
The natural history of UC in a low incidence country was less aggressive than the West. Over the past two decades, the rates of UC-related hospitalization and colectomy have been decreasing which were similar to the West.
背景/目的：泰国溃疡性结肠炎（UC）的发病率（粗发病率为每10万人0.28例）远低于西方。UC的负担在不同人群中有所不同。本研究的目的是评估泰国曼谷20年间UC的自然病程。
这项回顾性研究纳入了2000年至2018年期间在2所大学医院被诊断为UC的患者。为了评估疾病进程的变化，我们将患者分为2000 - 2009队列和2010 - 2018队列。使用Kaplan-Meier方法估计内镜愈合、UC相关住院和结肠切除术的累积概率。
共对291例UC患者进行了总计2228人年的随访。两个队列之间比较，疾病模式和严重程度无差异，但观察到口服和局部使用美沙拉嗪联合使用的增加以及硫唑嘌呤的早期使用。每个队列在5年时只有1%的患者需要生物制剂。3年时实现黏膜愈合的比例从15%增加到46%（P < 0.01）。5年时UC相关住院率从30%降至21%（P < 0.05）。5年时结肠切除率从6%降至2%（P < 0.05）。
低发病率国家UC的自然病程比西方的侵袭性小。在过去二十年中，UC相关住院和结肠切除率一直在下降，这与西方相似。
