Brochard Charlène, Rabilloud Marie-Laure, Hamonic Stéphanie, Bajeux Emma, Pagenault Maël, Dabadie Alain, Gerfaud Agathe, Viel Jean-François, Tron Isabelle, Robaszkiewicz Michel, Bretagne Jean-François, Siproudhis Laurent, Bouguen Guillaume
CHU Rennes, University of Rennes, INSERM, CIC1414, Institut NUMECAN (Nutrition Metabolism and Cancer), Rennes, France.
CHU Rennes, University of Rennes, Rennes, France.
Clin Gastroenterol Hepatol. 2022 Feb;20(2):e102-e110. doi: 10.1016/j.cgh.2020.12.024. Epub 2020 Dec 24.
The natural history of perianal Crohn's disease (PCD) remains poorly described and is mainly based on retrospective studies from referral centers. The aim of this study was to assess the incidence, outcomes and predictors of the onset of PCD.
All incident cases of patients diagnosed with possible CD were prospectively registered from 1994 to 1997 in Brittany, a limited area in France. At diagnosis, the clinical features of perianal disease were recorded. All patient charts were reviewed from the diagnosis to the last clinic visit in 2015.
Among the 272 out of 331 incident CD patients followed up, 51 (18.7%) patients had PCD at diagnosis. After a mean follow-up of 12.8 years, 93 (34%) patients developed PCD. The cumulative probabilities of perianal CD occurrence were 22%, 29%, and 32% after 1 year, 5 years, and 10 years, respectively. The cumulative probabilities of anal ulceration were 14%, and 19% after 1 year and 10 years, respectively. Extraintestinal manifestations were associated with the occurrence of anal ulceration. The cumulative probabilities of fistulizing PCD were 11%, 16%, and 19% after 1 year, 5 years, and 10 years, respectively. Extraintestinal manifestations, rectal involvement and anal ulceration were predictors of fistulizing PCD. The cumulative probability of developing anal stricture was 4% after 10 years.
PCD is frequently observed during CD, in approximately one-third of patients. These data underline the need for targeted therapeutic research on primary perianal lesions (proctitis, anal ulceration) to avoid the onset of fistulizing perianal disease.
肛周克罗恩病（PCD）的自然病史仍描述甚少，且主要基于转诊中心的回顾性研究。本研究旨在评估PCD发病的发生率、转归及预测因素。
1994年至1997年，在法国一个有限区域布列塔尼前瞻性登记所有诊断为可能克罗恩病（CD）的新发病例。诊断时，记录肛周疾病的临床特征。回顾所有患者从诊断至2015年最后一次门诊就诊的病历。
在331例随访的CD新发病例中，272例患者中51例（18.7%）诊断时有PCD。平均随访12.8年后，93例（34%）患者发生PCD。肛周CD发生的累积概率在1年、5年和10年后分别为22%、29%和32%。肛门溃疡的累积概率在1年和10年后分别为14%和19%。肠外表现与肛门溃疡的发生相关。1年、5年和10年后，瘘管性PCD的累积概率分别为11%、16%和19%。肠外表现、直肠受累及肛门溃疡是瘘管性PCD的预测因素。10年后发生肛门狭窄的累积概率为4%。
在CD患者中，约三分之一的患者经常观察到PCD。这些数据强调了针对原发性肛周病变（直肠炎、肛门溃疡）进行靶向治疗研究以避免瘘管性肛周疾病发生的必要性。
