Department of Gastroenterology and Inserm NGERE U1256, University Hospital of Nancy, University of Lorraine, 1 Allée du Morvan, 54511 Vandoeuvre-lès-Nancy, France; Nutritional Assistance Department, University Hospital of Nancy, University of Lorraine, Vandoeuvre-lès-Nancy, France.
Department of Gastroenterology and Inserm NGERE U1256, University Hospital of Nancy, University of Lorraine, 1 Allée du Morvan, 54511 Vandoeuvre-lès-Nancy, France; Department of Gastroenterology, University Hospital of Marseille Nord, University of Aix-Marseille, Marseille, France.
Dig Liver Dis. 2020 Dec;52(12):1455-1460. doi: 10.1016/j.dld.2020.08.029. Epub 2020 Sep 14.
Patients with Crohn's disease (CD) are at risk for short bowel syndrome (SBS). We investigated independent predictors for SBS in these patients to allow the development of preventive strategies.
All adult patients seen at the Nancy University hospital for CD or SBS between 2012 and 2019 were eligible for inclusion in this case-control study. Each CD patient with SBS was matched to 9 controls.
410 CD patients were included (369 without SBS and 41 with SBS). Subjects with SBS underwent significantly more bowel resections (median value of 3 vs 1, p<0.0001) and median time before the first surgery was not different than controls (6 vs 4 years, p=0.59). A higher need for parenteral support was found in end-jejunostomy SBS than in jejunocolic and jejunoileal SBS (70.6% vs 25% and 0%, p=0.0031). Montreal B1 behavior (OR 0.02, CI 95% 0-0.08) and budesonide treated-patients (OR=0.03, CI 95% 0.003-0.2) were at lower risk of SBS, while IV steroid treated-patients were at higher risk (OR=8.5, CI 95% 3.0-24.9).
Montreal B1 behavior, IV steroids and budesonide use are influencing predictors for this complication. These predictors should be assessed in daily clinical practice to prevent SBS occurrence.
克罗恩病（CD）患者存在发生短肠综合征（SBS）的风险。我们研究了这些患者发生 SBS 的独立预测因素，以便制定预防策略。
本病例对照研究纳入了 2012 年至 2019 年期间在法国南锡大学医院就诊的所有成年 CD 或 SBS 患者。每例 SBS 的 CD 患者均匹配 9 例对照。
共纳入 410 例 CD 患者（369 例无 SBS，41 例有 SBS）。SBS 患者接受的肠切除术明显更多（中位数 3 次比 1 次，p<0.0001），首次手术前的中位时间与对照组无差异（6 年比 4 年，p=0.59）。空肠吻合术 SBS 患者较空肠结肠和空肠回肠 SBS 患者更需要肠外支持（70.6%比 25%和 0%，p=0.0031）。蒙特利尔 B1 行为（OR 0.02，95%CI 0-0.08）和接受布地奈德治疗的患者（OR=0.03，95%CI 0.003-0.2）发生 SBS 的风险较低，而接受静脉用类固醇治疗的患者风险较高（OR=8.5，95%CI 3.0-24.9）。
蒙特利尔 B1 行为、IV 类固醇和布地奈德的使用是影响该并发症的预测因素。这些预测因素应在日常临床实践中进行评估，以预防 SBS 的发生。
