Al Khoury Alex, Singh Kelita, Kurti Zsuzsanna, Gonczi Lorant, Golovics Petra, Kohen Rita, Afif Waqqas, Wild Gary, Bitton Alain, Bessissow Talat, Lakatos Peter Laszlo
McGill University, Division of Gastroenterology Department of Medicine, Montreal, Canada. .
McGill University, Division of Gastroenterology Department of Medicine, Montreal, Canada.
J Gastrointestin Liver Dis. 2020 Dec 12;29(4):555-559. doi: 10.15403/jgld-2705.
Anemia is a common complication of inflammatory bowel diseases (IBD), as well as a predictor of poor outcomes. The aim of this study was to determine the prevalence of anemia over time and the management of moderate to severe anemia at a tertiary referral IBD center.
We retrospectively reviewed the occurrence of anemia at the time of referral or diagnosis and during follow-up at the McGill University Health Centre IBD center. Consecutive patients presenting with an outpatient visit between July and December 2016 and between December 2018 and March 2019 were included. Disease characteristics, biochemistry and medical management, including the need for intravenous iron therapy were recorded.
1,356 Crohn's disease (CD) and 1,293 ulcerative colitis (UC) patients [disease duration: 12 (IQR: 6-22) and 10 (IQR: 5-19) years respectively] were included. The prevalence of moderate to severe anemia at referral/diagnosis (15.4% and 8.5%) and during follow-up (11.1% and 8.1%) were higher in CD than in UC patients. In CD, previous resective surgery, perianal disease and elevated C-reactive protein (CRP) at assessment, while in UC steroid therapy, an elevated CRP and fecal calprotectin at assessment were associated with anemia in a multivariate analysis. Anemia improved by >2g/dL in 56.5% after 4-6 weeks (intravenous iron dose >1000 mg in 87% of patients).
Anemia occurred frequently in this IBD cohort, at referral to the center and during follow-up, and contributes to the burden of IBD in referral populations. Most patients were assessed for anemia regularly and with accurate anemia workup; however, the targeted management of moderate to severe anemia was suboptimal.
贫血是炎症性肠病（IBD）的常见并发症，也是预后不良的预测指标。本研究的目的是确定三级转诊IBD中心贫血随时间的患病率以及中重度贫血的管理情况。
我们回顾性分析了在麦吉尔大学健康中心IBD中心转诊或诊断时以及随访期间贫血的发生情况。纳入了2016年7月至12月以及2018年12月至2019年3月期间门诊就诊的连续患者。记录疾病特征、生化指标和医疗管理情况，包括静脉铁剂治疗的需求。
纳入了1356例克罗恩病（CD）患者和1293例溃疡性结肠炎（UC）患者[疾病病程分别为12（四分位间距：6 - 22）年和10（四分位间距：5 - 19）年]。转诊/诊断时（分别为15.4%和8.5%）以及随访期间（分别为11.1%和8.1%），CD患者中重度贫血的患病率高于UC患者。在CD患者中，多因素分析显示既往切除手术、肛周疾病以及评估时C反应蛋白（CRP）升高与贫血相关；而在UC患者中，类固醇治疗、评估时CRP升高以及粪便钙卫蛋白升高与贫血相关。4 - 6周后，56.5%的患者贫血改善超过2g/dL（87%的患者静脉铁剂剂量>1000mg）。
在这个IBD队列中，转诊至中心时以及随访期间贫血频繁发生，增加了转诊人群中IBD的负担。大多数患者定期接受贫血评估且检查准确；然而，中重度贫血的针对性管理并不理想。
