坏疽性脓皮病与炎症性肠袋相关并发症风险增加有关：一项回顾性队列研究。
Pyoderma Gangrenosum Is Associated With Increased Risk of Inflammatory Pouch-Related Complications: A Retrospective Cohort Study.
作者信息
Panganiban Ronaldo Paolo, Tuan Alyssa, Hart Maxwell, Pelton Mathew, Mikhail Daniella, Akhtar Sarah, Bogale Kaleb, Deiling Susan, Zhou Shouhao, Coates Mathew D, Yochum Gregory S, Koltun Walter
机构信息
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Penn State Hershey Medical Center, Hershey, PA, USA.
Division of Colorectal Surgery, Department of Surgery, Penn State Hershey Medical Center, Hershey, PA, USA.
出版信息
Crohns Colitis 360. 2023 May 14;5(3):otad024. doi: 10.1093/crocol/otad024. eCollection 2023 Jul.
BACKGROUND
Pyoderma gangrenosum (PG) is a rare, neutrophilic dermatosis that is a well-established extraintestinal manifestation (EIM) of inflammatory bowel disease. The clinical implications of developing PG in patients with ulcerative colitis (UC) who undergo total proctocolectomy colectomy and ileal pouch anal anastomosis (TPC-IPAA) surgery remain unknown.
METHODS
Study participants were selected from patients enrolled in the Carlino Family Inflammatory Bowel and Colorectal Disease Biobank between 1998 and 2021 with a pre-colectomy diagnosis of UC and who underwent TPC-IPAA surgery. A retrospective study comparing patients with PG and those without PG was performed. The outcomes measured included the development of pouchitis, pouchitis classification, presence of pouch fistula, anal fistula, anal stenosis, and pouch failure.
RESULTS
In this study, 357 IPAA patients were included, 10 of whom suffered PG. Patients with PG and without PG had similar demographics and clinical characteristics. Both groups had similar rates of pouchitis (80% in PG patients and 64% in patients without PG, = .504). However, IPAA patients with PG had a higher risk of developing pouch fistula (50% vs 10%, = .002), anal fistula (40% vs 12%, = .031), and Crohn's-like disease of the pouch (70% vs 15%, = .003) compared to patients without PG. Patients who developed PG prior to their first episode of pouchitis were more likely to eventually experience pouch failure (odds ratio: 20.7, 95% confidence interval: 3.9, 110.7, = 0.003 after false discovery rate adjustment).
CONCLUSIONS
Among UC patients who undergo TPC-IPAA surgery, the development of PG portends poor pouch outcomes and is predictive of pouch failure.
背景
坏疽性脓皮病（PG）是一种罕见的嗜中性皮肤病，是炎症性肠病公认的肠外表现（EIM）。在接受全直肠结肠切除术和回肠储袋肛管吻合术（TPC-IPAA）的溃疡性结肠炎（UC）患者中发生PG的临床意义尚不清楚。
方法
研究参与者选自1998年至2021年在Carlino家族炎症性肠病和结直肠癌生物样本库登记的患者，这些患者在结肠切除术前被诊断为UC并接受了TPC-IPAA手术。对患有PG和未患有PG的患者进行了一项回顾性研究。测量的结果包括袋炎的发生、袋炎分类、袋瘘、肛瘘、肛门狭窄和储袋功能衰竭的存在情况。
结果
本研究纳入了357例IPAA患者，其中10例患有PG。患有PG和未患有PG的患者在人口统计学和临床特征方面相似。两组的袋炎发生率相似（PG患者为80%，未患有PG的患者为64%，P = 0.504）。然而，与未患有PG的患者相比，患有PG的IPAA患者发生袋瘘（50%对10%，P = 0.002）、肛瘘（40%对12%，P = 0.031）和储袋克罗恩样疾病（70%对15%，P = 0.003）的风险更高。在首次发生袋炎之前就出现PG的患者最终更有可能经历储袋功能衰竭（比值比：20.7，95%置信区间：3.9，110.7，经错误发现率调整后P = 0.003）。
结论
在接受TPC-IPAA手术的UC患者中，PG的发生预示着储袋预后不良，并可预测储袋功能衰竭。
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