Forbes Angela J, Frampton Chris M A, Day Andrew S, DeVries Millie, McVicar Nina, Su Heidi, Gearry Richard B
Department of Medicine University of Otago Christchurch Christchurch New Zealand.
Department of Paediatrics University of Otago Christchurch Christchurch New Zealand.
JGH Open. 2024 Oct 14;8(10):e70038. doi: 10.1002/jgh3.70038. eCollection 2024 Oct.
Inflammatory bowel disease (IBD) is a progressive condition where ongoing inflammation in the gastrointestinal tract can lead to complications such as strictures, and fistulae. The long-term outcomes of newly diagnosed patients under current medical therapy can be used to plan health service provision and guide patients.
Prospective population-based data on all incident patients diagnosed with IBD in Canterbury was gathered in 2014 ( = 205). The medical records of these patients were followed for medication use, disease progression, hospitalization, surgery and mortality, in the 10 years since their diagnosis. Survival analysis and cox regression determined characteristics associated with earlier time to these outcomes.
Medical records of 184 IBD patients were able to be retrieved. Immunomodulators were used by 62% and biologics by 35%; hospitalization occurred for 42% and surgery for 15%. Montreal phenotype progression occurred for 21 and 7% of the cohort died. Younger age at diagnosis hazard ratio (HR) 2.1 (95% confidence interval [CI] 1.1-4.0) and Crohn's disease HR 1.7 (95% CI 1.1-2.6) was associated with immunomodulator use. Younger age was also associated with biologic use HR 2.9 (95% CI 1.2-6.9). Male gender was associated with surgery HR 2.8 (95% CI 1.2-6.4). Perianal disease at diagnosis (14.7%) was associated with immunomodulator use HR 2.58 (95% CI 1.44-4.59) and Montreal phenotype progression HR 2.93 (95% CI 1.10-7.77).
In the 10 years since diagnosis disease progression and treatment escalation occurred for most of this population-based cohort. Earlier intervention for patients with higher-risk characteristics may improve long-term outcomes reducing the burden on health systems.
炎症性肠病（IBD）是一种进行性疾病，胃肠道的持续炎症可导致诸如狭窄和瘘管等并发症。新诊断患者在当前药物治疗下的长期预后可用于规划医疗服务提供并指导患者。
2014年收集了坎特伯雷所有新诊断为IBD的患者的基于人群的前瞻性数据（n = 205）。对这些患者的病历进行了随访，记录了自诊断以来10年中的用药情况、疾病进展、住院情况、手术情况和死亡率。生存分析和Cox回归确定了与这些结局较早发生时间相关的特征。
能够检索到184例IBD患者的病历。62%的患者使用了免疫调节剂，35%的患者使用了生物制剂；42%的患者住院，15%的患者接受了手术。21%的队列出现蒙特利尔表型进展，7%的患者死亡。诊断时年龄较小（风险比[HR] 2.1，95%置信区间[CI] 1.1 - 4.0）和克罗恩病（HR 1.7，95% CI 1.1 - 2.6）与免疫调节剂的使用相关。年龄较小也与生物制剂的使用相关（HR 2.9，95% CI 1.2 - 6.9）。男性与手术相关（HR 2.8，95% CI 1.2 - 6.4）。诊断时的肛周疾病（14.7%）与免疫调节剂的使用相关（HR 2.58，95% CI 1.44 - 4.59）和蒙特利尔表型进展相关（HR 2.93，95% CI 1.10 - 7.77）。
在诊断后的10年中，该基于人群的队列中的大多数患者出现了疾病进展和治疗升级。对具有高风险特征的患者进行早期干预可能会改善长期预后，减轻卫生系统的负担。
