生物治疗或手术后克罗恩病患者的疾病复发：一项荟萃分析。

Disease recurrence in patients with Crohn's disease after biologic therapy or surgery: a meta-analysis.

机构信息

Department of Internal Medicine IV (Gastroenterology, Hepatology, and Infectious Diseases), Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany.

Institute for Medical Statistics, Informatics and Data Science, University Hospital Jena, Bachstr. 18, 07743, Jena, Germany.

出版信息

Int J Colorectal Dis. 2022 Oct;37(10):2185-2195. doi: 10.1007/s00384-022-04254-z. Epub 2022 Sep 23.

BACKGROUND

Relapse is a problem in patients with Crohn's disease (CD) after medical therapy (including biologics) and after surgery to treat acute inflammation. It is unclear whether the recurrence rate over time is higher after surgical therapy than after continuous drug treatment.

AIM

We sought to compare clinical relapse rates and the need for re-interventions (resection or therapeutic endoscopic intervention) in patients with CD.

METHODS

A meta-analysis was performed according to PRISMA guidelines.

RESULTS

The need for one of the three re-interventions (surgery, biologics or both) increased over time. The recurrence rates in patients after ileocecal resection were lower than the rates under biologic therapy. The odds ratio for clinical recurrence under biologics versus after surgical treatment was 2.50 (95% confidence interval [CI] 1.53-4.08, p-value < 0.001). The odds ratio for surgical recurrence under biologics versus after surgery was 3.60 (95% CI 1.06-12.3, p-value 0.041).

CONCLUSION

These findings support surgical resection as a treatment option in patients with CD with limited disease.

背景

克罗恩病（CD）患者在接受药物治疗（包括生物制剂）和治疗急性炎症的手术后会出现复发的问题。目前尚不清楚手术治疗后的复发率是否高于持续药物治疗。

目的

我们旨在比较 CD 患者的临床复发率和需要再次干预（切除或治疗性内镜干预）的情况。

方法

根据 PRISMA 指南进行了荟萃分析。

结果

需要三种干预措施（手术、生物制剂或两者兼有）之一的情况随着时间的推移而增加。回肠末端切除术患者的复发率低于生物制剂治疗组。生物制剂治疗后临床复发的几率是非手术治疗的 2.50 倍（95%置信区间 [CI] 1.53-4.08，p 值 < 0.001）。生物制剂治疗后手术复发的几率是非手术治疗的 3.60 倍（95% CI 1.06-12.3，p 值 0.041）。