老年炎症性肠病患者的疾病和治疗相关并发症：成人发病与老年发病的比较。
Disease- and Treatment-related Complications in Older Patients With Inflammatory Bowel Diseases: Comparison of Adult-onset vs Elderly-onset Disease.
机构信息
Department of Internal Medicine, University of California San Diego, La Jolla, California, USA.
Division of Biostatistics and Bioinformatics, Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California, USA.
出版信息
Inflamm Bowel Dis. 2021 Jul 27;27(8):1215-1223. doi: 10.1093/ibd/izaa308.
BACKGROUND
The incidence and prevalence of inflammatory bowel diseases (IBD) in older adults are rising. There is a limited comparative assessment of risk of disease- and treatment-related complications in older patients (older than 60 years) with adult-onset (age at disease onset, 18-59 years; AO-IBD) vs elderly-onset IBD (age at disease onset, older than 60 years; EO-IBD). We compared clinical outcomes in older patients with IBD with AO-IBD vs EO-IBD.
METHODS
We conducted a retrospective cohort study comparing risk of disease-related complications (IBD-related surgery, hospitalization, treatment escalation, clinical flare, or disease complication) and treatment-related complications (serious infection, malignancy, or death) in older patients with AO-IBD vs EO-IBD through Cox proportional hazard analysis, adjusting for age at cohort entry, disease phenotype, disease duration, prior surgery and/or hospitalization, medication use, disease activity at cohort entry, and comorbidities.
RESULTS
We included 356 older patients with IBD (AO-IBD, 191 patients, 67 ± 5 y at cohort entry; EO-IBD, 165 patients, 72 ± 8 y at cohort entry). No significant differences were observed in the risk of disease-related complications in older patients with prevalent vs incident IBD (adjusted hazard ratio [aHR], 0.85; 95% CI, 0.58-1.25), although risk of IBD-related surgery was lower in older patients with prevalent IBD (aHR, 0.47; 95% CI, 0.25-0.89). Older patients with prevalent IBD were significantly less likely to experience treatment-related complications (aHR, 0.58; 95% CI, 0.39-0.87).
CONCLUSION
Patients with AO-IBD have lower risk of treatment-related complications as they age compared with patients with EO-IBD, without a significant difference in risk of disease-related complications.
背景
炎症性肠病（IBD）在老年人中的发病率和患病率正在上升。对于成人发病（发病年龄为 18-59 岁；AO-IBD）与老年发病 IBD（发病年龄大于 60 岁；EO-IBD）的老年患者，疾病和治疗相关并发症的风险比较评估有限。我们比较了患有 IBD 的老年患者中，AO-IBD 与 EO-IBD 的临床结局。
方法
我们进行了一项回顾性队列研究，通过 Cox 比例风险分析比较了 AO-IBD 与 EO-IBD 老年患者的疾病相关并发症（IBD 相关手术、住院、治疗升级、临床发作或疾病并发症）和治疗相关并发症（严重感染、恶性肿瘤或死亡）的风险，调整了队列入组时的年龄、疾病表型、疾病持续时间、既往手术和/或住院、药物使用、队列入组时的疾病活动度和合并症。
结果
我们纳入了 356 名患有 IBD 的老年患者（AO-IBD，191 名患者，队列入组时的年龄为 67±5 岁；EO-IBD，165 名患者，队列入组时的年龄为 72±8 岁）。在患有现患或新发 IBD 的老年患者中，疾病相关并发症的风险无显著差异（调整后的危险比 [aHR]，0.85；95%CI，0.58-1.25），尽管现患 IBD 患者的 IBD 相关手术风险较低（aHR，0.47；95%CI，0.25-0.89）。患有现患 IBD 的老年患者发生治疗相关并发症的风险显著较低（aHR，0.58；95%CI，0.39-0.87）。
结论
与 EO-IBD 患者相比，随着年龄的增长，AO-IBD 患者的治疗相关并发症风险较低，而疾病相关并发症的风险无显著差异。
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