Han Dong Yoon, You Myung-Won, Oh Chi Hyuk, Park Seong Jin
Department of Radiology, Kyung Hee University College of Medicine, Kyung Hee University Hospital, Seoul 02447, Republic of Korea.
Department of Internal Medicine, Kyung Hee University College of Medicine, Kyung Hee University Hospital, Seoul 02447, Republic of Korea.
Diagnostics (Basel). 2023 Jan 11;13(2):273. doi: 10.3390/diagnostics13020273.
Background: Crohn’s disease (CD) manifests a heterogeneous clinical spectrum and disease course, and it is challenging to predict the disease outcome based on initial presentation. Objective: To analyze the long-term disease course and factors leading to poor prognosis of CD. Methods: In total, 112 patients with CD who were initially diagnosed and treated at our institution from January 2009 to August 2020 were included. We analyzed their clinical data, disease characteristics according to the Montreal classification, and the endoscopic and computed tomography (CT) examinations at the initial visit and at 2-year, 5-year, and last follow ups. We categorized the disease course into the following four categories: remission, stable, chronic refractory, and chronic relapsing. Significant factors associated with a poorer prognosis were analyzed. Results: The median follow-up period was 107 (range, 61−139) months. Complicated disease behavior increased slightly over the follow-up period (20.5% to 26.2%). An unfavorable disease course was defined as chronic refractory (19.6%) and relapsing (16.1%) courses. The 2-year disease characteristics were significant factors for unfavorable disease course, and the combination of 2-year perianal disease and 2-year moderate-to-severe CT activity could predict unfavorable disease course with the highest accuracy (0.722; area under the curve: 0.768; p < 0.0001). Conclusions: One-third of the patients with CD showed an unfavorable disease course (35.7%), and 2-year disease characteristics were significant factors for an unfavorable disease course.
克罗恩病（CD）表现出异质性的临床谱和病程，基于初始表现预测疾病结局具有挑战性。目的：分析CD的长期病程及导致预后不良的因素。方法：纳入2009年1月至2020年8月在本机构初诊并接受治疗的112例CD患者。分析其临床资料、根据蒙特利尔分类的疾病特征，以及初诊时、2年、5年和末次随访时的内镜及计算机断层扫描（CT）检查结果。将病程分为以下四类：缓解、稳定、慢性难治性和慢性复发性。分析与预后较差相关的显著因素。结果：中位随访期为107（范围61 - 139）个月。随访期间复杂疾病行为略有增加（从20.5%至26.2%）。不良病程定义为慢性难治性（19.6%）和复发性（16.1%）病程。2年时的疾病特征是不良病程的显著因素，2年肛周疾病和2年中重度CT活动度的组合预测不良病程的准确性最高（0.722；曲线下面积：0.768；p < 0.0001）。结论：三分之一的CD患者表现出不良病程（35.7%），2年时的疾病特征是不良病程的显著因素。
