克罗恩病的表型及其与合并症、手术风险、药物治疗和非药物治疗方法的关联：IMAGINE研究中的MAGIC研究
Crohn's Disease Phenotypes and Associations With Comorbidities, Surgery Risk, Medications and Nonmedication Approaches: The MAGIC in IMAGINE Study.
作者信息
Bernstein Charles N, Panaccione Remo, Nugent Zoann, Marshall Deborah A, Kaplan Gilaad G, Vanner Stephen, Dieleman Levinus A, Graff Lesley A, Otley Anthony, Jones Jennifer, Buresi Michelle, Murthy Sanjay, Borgaonkar Mark, Bressler Brian, Bitton Alain, Croitoru Kenneth, Sidani Sacha, Fernandes Aida, Moayyedi Paul
机构信息
Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
University of Manitoba Inflammatory Bowel Disease Clinical and Research Centre, Winnipeg, Canada.
出版信息
Inflamm Bowel Dis. 2025 Jan 6;31(1):113-122. doi: 10.1093/ibd/izae055.
BACKGROUND
We aimed to establish a cohort of persons with Crohn's disease (CD) enrolled from 14 Canadian centers to describe the contemporary presentation of CD in Canada.
METHODS
All enrollees were at least 18 years old and underwent chart review for phenotype documentation by Montreal Classification at time of enrollment, comorbidities, inflammatory bowel disease (IBD) and other surgeries, and use IBD and other therapies.
RESULTS
Of 2112 adults, 59% were female, and the mean age was 44.1 (+/-14.9SD) years. The phenotype distribution was B1 = 50.4%, B2 = 22.4%, B3 = 17.3%, and missing information = 9.9%. Perineal disease was present in 14.2%. Pertaining to disease location, 35.2% of patients had disease in L1, 16.8% in L2, 48% in L3, and 0.4% in L4. There was no difference in phenotype by gender, anxiety score, depression score. Disease duration was significantly different depending on disease behavior type (B1 = 12.2 ± 10.1; B2 = 19.4 ± 12.9; B3 = 18.9 ± 11.8, P < .0001). Isolated colonic disease was much less likely to be fibrostenotic or penetrating than inflammatory disease. Penetrating disease was more likely to be associated with ileocolonic location than other locations. Perineal disease was most commonly seen in persons with B3 disease behavior (24%) than other behaviors (11% B1; 20% B2 disease, P < .0001) and more likely to be seen in ileocolonic disease (L3;19%) vs L2 (17%) and L1 (11%; P < .0001). Surgery related to IBD occurred across each behavior types at the following rates: B1 = 23%, B2 = 64%, and B3 = 74%. Inflammatory bowel disease-related surgery rates by location of disease were L1 = 48%, L2 = 21%, and L3 = 51%.
CONCLUSIONS
In exploring this large contemporary CD cohort we have determined that inflammatory disease is the main CD phenotype in Canada and that CD-related surgery remains very common.
背景
我们旨在建立一个来自加拿大14个中心的克罗恩病（CD）患者队列，以描述加拿大CD的当代临床表现。
方法
所有入组者年龄至少18岁，在入组时接受病历审查，以通过蒙特利尔分类记录表型、合并症、炎症性肠病（IBD）及其他手术情况，以及IBD和其他治疗的使用情况。
结果
在2112名成年人中，59%为女性，平均年龄为44.1（±14.9标准差）岁。表型分布为B1 = 50.4%，B2 = 22.4%，B3 = 17.3%，信息缺失 = 9.9%。14.2%的患者存在会阴疾病。关于疾病部位，35.2%的患者病变位于L1，16.8%位于L2，48%位于L3，0.4%位于L4。表型在性别、焦虑评分、抑郁评分方面无差异。疾病持续时间根据疾病行为类型有显著差异（B1 = 12.2 ± 10.1；B2 = 19.4 ± 12.9；B3 = 18.9 ± 11.8，P <.0001）。孤立性结肠疾病发生纤维狭窄或穿透的可能性远低于炎症性疾病。穿透性疾病与回结肠部位相关的可能性高于其他部位。会阴疾病在B3疾病行为患者中最常见（24%），高于其他行为类型（B1为11%；B2疾病为20%，P <.0001），且在回结肠疾病（L3；19%）中比在L2（17%）和L1（11%；P <.0001）中更常见。与IBD相关的手术在各行为类型中的发生率如下：B1 = 23%，B2 = 64%，B3 = 74%。按疾病部位划分的IBD相关手术率为L1 = 48%，L2 = 21%，L3 = 51%。
结论
通过对这个大型当代CD队列的研究，我们确定炎症性疾病是加拿大CD的主要表型，且与CD相关的手术仍然非常常见。
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