既往阑尾切除术与克罗恩病较轻的临床病程相关：一项基于全国人群的队列研究

Prior Appendectomy Is Associated With a Milder Clinical Course in Crohn's Disease: A Nationwide Population-based Cohort Study.

作者信息

Mark-Christensen Anders, Kristiansen Eskild Bendix, Laurberg Søren, Erichsen Rune

机构信息

Department of Clinical Epidemiology, Aarhus University Hospital, Århus, Denmark.

Department of Surgery, Odense University Hospital, Odense, Denmark.

出版信息

Inflamm Bowel Dis. 2025 Jan 6;31(1):123-130. doi: 10.1093/ibd/izae059.

DOI:10.1093/ibd/izae059

PMID:38564416

Abstract

BACKGROUND

Appendectomy may affect the clinical course of Crohn's disease (CD), but rigorous evidence is sparse and contradicting. The aim of this study was to examine the association between appendectomy and the clinical course of CD.

METHODS

All patients diagnosed with CD in Denmark in the period from 1977 to 2017 were identified from the Danish National Patient Registry. Patients with appendectomy were matched with up to 10 comparators with CD and no appendectomy; and rates of CD-related hospital admissions were compared between CD patients with and without appendectomy using incidence rate ratios (IRRs). We used stratified Cox regression analysis to calculate adjusted hazard ratios (aHRs) of initiating treatment with biologics or undergoing intestinal resections.

RESULTS

In all, 21 189 CD patients (1936 with appendectomy and 19 253 without) were identified and followed for a median of 13.6 years. Crohn's disease patients who had undergone appendectomy experienced a lower rate of CD-related hospital admissions (appendectomy before CD: IRR = 0.83; 95% confidence interval [CI], 0.81-0.85; appendectomy after CD: IRR = 0.85; 95% CI, 0.81-0.88) compared with CD patients without appendectomy. For patients with appendectomy before CD diagnosis, the rate of initiating biologics was lower compared with CD patients with no appendectomy (aHR1-<5 years = 0.61; 95% CI, 0.46-0.81; aHR5-<10 years 0.47; 95% CI, 0.33-0.66; aHR10-20 years = 0.61; 95% CI, 0.47-0.79), as was the risk of undergoing colorectal resections (aHR1-<5 years = 0.94; 95% CI, 0.77-1.15; aHR5-<10 years 0.63; 95% CI, 0.47-0.85; aHR10-20 years = 0.75; 95% CI, 0.54-1.04). Rates of small bowel resections were comparable for CD patients with or without appendectomy prior to CD. Appendectomy performed after CD did not influence the rate of initiating treatment with biologics or undergoing intestinal resections.

CONCLUSION

The clinical course of CD is milder for those who have previously undergone appendectomy.

摘要

背景

阑尾切除术可能会影响克罗恩病（CD）的临床病程，但确凿的证据稀少且相互矛盾。本研究的目的是探讨阑尾切除术与CD临床病程之间的关联。

方法

从丹麦国家患者登记处识别出1977年至2017年期间在丹麦被诊断为CD的所有患者。将接受阑尾切除术的患者与多达10名患有CD但未接受阑尾切除术的对照者进行匹配；使用发病率比（IRR）比较接受和未接受阑尾切除术的CD患者的CD相关住院率。我们使用分层Cox回归分析来计算开始使用生物制剂治疗或接受肠道切除术的调整风险比（aHR）。

结果

总共识别出21189例CD患者（1936例接受阑尾切除术，19253例未接受），并进行了中位数为13.6年的随访。与未接受阑尾切除术的CD患者相比，接受阑尾切除术的克罗恩病患者的CD相关住院率较低（CD之前进行阑尾切除术：IRR = 0.83；95%置信区间[CI]，0.81 - 0.85；CD之后进行阑尾切除术：IRR = 0.85；95% CI，0.81 - 0.88）。对于在CD诊断之前接受阑尾切除术的患者，与未接受阑尾切除术的CD患者相比，开始使用生物制剂的比率较低（aHR1 - <5年 = 0.61；95% CI，0.46 - 0.81；aHR5 - <10年 = 0.47；95% CI，0.33 - 0.66；aHR10 - 20年 = 0.61；95% CI，0.47 - 0.79），接受结直肠切除术的风险也是如此（aHR1 - <5年 = 0.94；95% CI，0.77 - 1.15；aHR5 - <10年 = 0.63；95% CI，0.47 - 0.85；aHR10 - 20年 = 0.75；95% CI，0.54 - 1.04）。在CD之前接受或未接受阑尾切除术的CD患者的小肠切除术发生率相当。CD之后进行的阑尾切除术不影响开始使用生物制剂治疗或接受肠道切除术的比率。