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, Yang Suk-Kyun
Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
Department of Biochemistry, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
J Gastroenterol Hepatol. 2021 Jun;36(6):1571-1579. doi: 10.1111/jgh.15308. Epub 2020 Nov 15.
The clinical impact of perianal Crohn's disease (CD) (pCD), a well-known poor prognostic factor of CD, has not been fully evaluated in Asian patients. We investigated the outcomes of CD in Korean patients according to the presence of pCD at CD diagnosis.
Using 2010-2014 data from the national health insurance claims database, we evaluated the disease course of CD according to the presence of pCD at CD diagnosis. The results were verified in a hospital-based cohort of 2923 patients.
The cumulative risk of intestinal resection was lower in patients with pCD at diagnosis than in those without, in the population-based cohort (9.1% vs 14.7% at 5 years after diagnosis, P < 0.001), but it was similar between the two groups in the hospital-based cohort (36.8% vs 36.8% at 10 years after diagnosis, P = 0.950). Moreover, the cumulative risk of behavioral progression was not significantly different between the two groups in the hospital-based cohort (43.4% vs 41.6% at 10 years after diagnosis, P = 0.366). On multivariable analysis, pCD at CD diagnosis was not a predictor of intestinal resection, behavioral progression, CD-related hospital admission, or diverting surgery; however, it was an independent predictor of proctectomy (hazard ratio [HR] 3.210, P < 0.001) and anorectal cancer (HR 3.104, P = 0.047).
Although the presence of pCD increased the risk of proctectomy and anorectal cancer in Asian patients, the clinical impact of pCD on the overall outcomes of patients with CD may be less significant in Asian patients compared with Western patients.
肛周克罗恩病（pCD）是克罗恩病（CD）一个众所周知的不良预后因素，其对亚洲患者的临床影响尚未得到充分评估。我们根据CD诊断时pCD的存在情况，调查了韩国CD患者的预后。
利用国家健康保险索赔数据库2010 - 2014年的数据，我们根据CD诊断时pCD的存在情况评估了CD的病程。结果在一个基于医院的2923例患者队列中得到验证。
在基于人群的队列中，诊断时患有pCD的患者肠道切除的累积风险低于未患pCD的患者（诊断后5年时分别为9.1%和14.7%，P < 0.001），但在基于医院的队列中两组相似（诊断后10年时分别为36.8%和36.8%，P = 0.950）。此外，在基于医院的队列中，两组行为进展的累积风险无显著差异（诊断后10年时分别为43.4%和41.6%，P = 0.366）。多变量分析显示，CD诊断时的pCD不是肠道切除、行为进展、CD相关住院或转流手术的预测因素；然而，它是直肠切除术（风险比[HR] 3.210，P < 0.001）和肛管直肠癌（HR 3.104，P = 0.047）的独立预测因素。
虽然pCD的存在增加了亚洲患者直肠切除术和肛管直肠癌的风险，但与西方患者相比，pCD对亚洲CD患者总体预后的临床影响可能较小。
