中东老年和早发性炎症性肠病的疾病表型和病程比较。

Comparison of Disease Phenotype and Course among Elderly- and Early-Onset Inflammatory Bowel Diseases in the Middle East.

机构信息

Gastroenterology and Hepatology Department, Faculty of Medicine, Ghaem Hospital, Mashhad, Iran.

Digestive Disease Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran.

出版信息

Arch Iran Med. 2023 Sep 1;26(9):481-488. doi: 10.34172/aim.2023.73.

DOI:10.34172/aim.2023.73

PMID:38310403

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10862057/

Abstract

BACKGROUND

It is unknown if the clinical manifestations and phenotype of disease are comparable between early- and elderly-onset inflammatory bowel disease (IBD). We aimed to seek differences in disease phenotype, course, complications, and treatment between early- and elderly-onset IBD patients.

METHODS

This retrospective cohort study on registered IBD patients in the Iranian Registry of Crohn's and Colitis (IRCC) compared demographics, disease phenotype, disease activity, IBD-related surgery and medications between early- and elderly-onset IBD. A generalized linear regression model was used to investigate the relative risk of age at diagnosis adjusted for gender and disease duration for the outcomes.

RESULTS

From 10048 IBD patients, 749 with early-onset (7.5%), and 472 (4.7%) elderly-onset IBD were enrolled: 855 (63.1%) ulcerative colitis (UC) and 366 (26.9%) Crohn's disease (CD). Left-sided colitis was more frequent among elderly-onset UC patients (<0.001). Ileum and ileocolonic locations were the most common types in elderly-onset and early-onset CD patients, respectively. In comparison with elderly-onset UC, early-onset cases more often used prednisolone (22.1% vs. 11.4%, =0.001), immunomodulators (44.9% vs 25.2%, <0.001) and anti-tumor necrosis factors (TNF) (20.1% vs 11.9%, =0.002). Elderly-onset UC patients had 0.7 times lower risk of aggressive phenotype (95%CI:0.6‒0.9, =0.005). Early-onset CD was associated with higher use of prednisolone (27.7% vs 8.1%, <0.001), immunomodulators (58.7% vs 41.8%, =0.005) and anti-TNF (49.6% vs 35.4%, =0.006).

CONCLUSION

Early-onset IBD was associated with a more aggressive phenotype and higher prednisolone, immunomodulators, and anti-TNF use.

摘要

背景

目前尚不清楚早发型和老年型炎症性肠病（IBD）的临床表现和疾病表型是否具有可比性。我们旨在探讨早发型和老年型 IBD 患者在疾病表型、病程、并发症和治疗方面的差异。

方法

本项基于伊朗克罗恩病和结肠炎注册研究（IRCC）的回顾性队列研究比较了早发型和老年型 IBD 患者的人口统计学、疾病表型、疾病活动度、IBD 相关手术和药物治疗情况。使用广义线性回归模型，针对性别和疾病持续时间调整诊断时年龄的相对风险进行分析。

结果

在 10048 例 IBD 患者中，纳入了 749 例早发型（7.5%）和 472 例老年型（4.7%）IBD 患者：855 例溃疡性结肠炎（UC）和 366 例克罗恩病（CD）。老年型 UC 患者中左半结肠炎更为常见（<0.001）。老年型和早发型 CD 患者中最常见的病变部位分别为回肠和回结肠。与老年型 UC 相比，早发型 UC 患者更常使用泼尼松龙（22.1%比 11.4%，=0.001）、免疫调节剂（44.9%比 25.2%，<0.001）和抗肿瘤坏死因子（TNF）（20.1%比 11.9%，=0.002）。老年型 UC 患者具有 0.7 倍低风险的侵袭性表型（95%CI：0.6-0.9，=0.005）。早发型 CD 与泼尼松龙（27.7%比 8.1%，<0.001）、免疫调节剂（58.7%比 41.8%，=0.005）和抗 TNF（49.6%比 35.4%，=0.006）的使用率更高相关。