Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Digestive Diseases Research Center, University of Ulsan College of Medicine, Seoul, Korea.
Gut Liver. 2022 Nov 15;16(6):907-920. doi: 10.5009/gnl210299. Epub 2022 Mar 24.
BACKGROUND/AIMS: The prospective Crohn's Disease Clinical Network and Cohort Study is a nationwide multicenter cohort study of patients with Crohn's disease (CD) in Korea, aiming to prospectively investigate the clinical features and long-term prognosis associated with CD.
Patients diagnosed with CD between January 2009 and September 2019 were prospectively enrolled. They were divided into two cohorts according to the year of diagnosis: cohort 1 (diagnosed between 2009 and 2011) versus cohort 2 (between 2012 and 2019).
A total of 1,175 patients were included, and the median follow-up duration was 68 months (interquartile range, 39.0 to 91.0 months). The treatment-free durations for thiopurines (p<0.001) and anti-tumor necrosis factor agents (p=0.018) of cohort 2 were shorter than those of cohort 1. Among 887 patients with B1 behavior at diagnosis, 149 patients (16.8%) progressed to either B2 or B3 behavior during follow-up. Early use of thiopurine was associated with a reduced risk of behavioral progression (adjusted hazard ratio [aHR], 0.69; 95% confidence interval [CI], 0.50 to 0.90), and family history of inflammatory bowel disease was associated with an increased risk of behavioral progression (aHR, 2.29; 95% CI, 1.16 to 4.50). One hundred forty-one patients (12.0%) underwent intestinal resection, and the intestinal resection-free survival time was significantly longer in cohort 2 than in cohort 1 (p=0.003). The early use of thiopurines (aHR, 0.35; 95% CI, 0.23 to 0.51) was independently associated with a reduced risk of intestinal resection.
The prognosis of CD in Korea appears to have improved over time, as evidenced by the decreasing intestinal resection rate. Early use of thiopurines was associated with an improved prognosis represented by a reduced risk of intestinal resection.
背景/目的：前瞻性克罗恩病临床网络和队列研究是一项针对韩国克罗恩病（CD）患者的全国多中心队列研究，旨在前瞻性研究与 CD 相关的临床特征和长期预后。
本研究前瞻性纳入 2009 年 1 月至 2019 年 9 月期间诊断为 CD 的患者。根据诊断年份将患者分为两个队列：队列 1（2009 年至 2011 年诊断）和队列 2（2012 年至 2019 年诊断）。
共纳入 1175 例患者，中位随访时间为 68 个月（四分位距，39.0 至 91.0 个月）。队列 2 中硫唑嘌呤（p<0.001）和抗 TNF 药物（p=0.018）的无治疗持续时间短于队列 1。在 887 例诊断时表现为 B1 行为的患者中，149 例（16.8%）在随访期间进展为 B2 或 B3 行为。早期使用硫唑嘌呤与降低行为进展风险相关（调整后的风险比 [aHR]，0.69；95%置信区间 [CI]，0.50 至 0.90），炎症性肠病家族史与行为进展风险增加相关（aHR，2.29；95% CI，1.16 至 4.50）。141 例（12.0%）患者接受了肠切除术，队列 2 的肠切除术无复发生存时间明显长于队列 1（p=0.003）。早期使用硫唑嘌呤（aHR，0.35；95% CI，0.23 至 0.51）与降低肠切除术风险独立相关。
韩国 CD 的预后似乎随着时间的推移而改善，这体现在肠切除术率的降低上。早期使用硫唑嘌呤可降低肠切除术风险，从而改善预后。
