Zhan Wei, Bai Xiaoyin, Yang Hong, Qian Jiaming
Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Intest Res. 2024 Oct;22(4):484-495. doi: 10.5217/ir.2024.00021. Epub 2024 Jul 15.
BACKGROUND/AIMS: Crohn's disease (CD) has a progressive nature and commonly perianal involvement. The aim of this study is to assess the prevalence, surgical treatment, and outcome of perianal fistulizing CD with associated risk factors in a large Chinese cohort.
Hospitalized patients diagnosed with CD in our center were consecutively enrolled between January 2000 and December 2018. Transition of disease behavior was classified according to the presence or absence of penetrating behavior (B3 in the Montreal classification) at diagnosis and at a median follow-up of 102 months.
A total of 504 patients were included, of whom 207 (41.1%) were classified as B3 and 348 (69.0%) as L2/3 at follow-up. Transition of behavior to B3 was observed in 86 patients (17.1%). The incidence of perianal fistulizing lesions was 10.9% at 10 years with a final prevalence of 27.0% (n = 136) at the end of follow-up. Multivariate Cox regression identified independent risks of perianal fistulizing lesions for persistent B3 (hazard ratio, 4.72; 95% confidence interval, 1.91-11.66) and behavior transition of progressed to B3 (hazard ratio, 9.90; 95% confidence interval, 4.60-21.33). Perianal surgical treatments were performed in 104 patients (20.6%). Thirty-six cases (7.1%) were refractory, and it is independently associated with behavior of persistent B3 (P= 0.011).
Perianal fistulizing lesions occurred frequently in Chinese CD patients. Its incidence and refractory outcome were closely associated with the penetrating CD behavior. An additional risk of perianal fistulizing lesions was indicated for CD patients with behavior of progressing to B3, suggesting further attention.
背景/目的：克罗恩病（CD）具有进行性特点，常累及肛周。本研究旨在评估中国一个大型队列中肛周瘘管型CD的患病率、手术治疗及结局，并分析相关危险因素。
2000年1月至2018年12月期间，连续纳入在本中心确诊为CD的住院患者。根据诊断时及中位随访102个月时是否存在穿透性病变行为（蒙特利尔分类中的B3）对疾病行为转变进行分类。
共纳入504例患者，其中207例（41.1%）在随访时被分类为B3，348例（69.0%）为L2/3。86例患者（17.1%）出现行为转变为B3。10年时肛周瘘管病变的发生率为10.9%，随访结束时最终患病率为27.0%（n = 136）。多因素Cox回归分析确定持续B3行为（风险比，4.72；95%置信区间，1.91 - 11.66）和进展为B3的行为转变（风险比，9.90；95%置信区间，4.60 - 21.33）是肛周瘘管病变的独立危险因素。104例患者（20.6%）接受了肛周手术治疗。36例（7.1%）为难治性病例，且与持续B3行为独立相关（P = 0.011）。
肛周瘘管病变在中国CD患者中频繁发生。其发生率和难治性结局与穿透性CD行为密切相关。进展为B3行为的CD患者存在发生肛周瘘管病变的额外风险，提示需进一步关注。
