克罗恩病以回肠为主与肠道手术增加、生物治疗使用增加以及治疗持续性降低相关。
Ileal Predominance in Crohn's Disease Is Associated With Increased Intestinal Surgery and Biological Therapy Use, With Lower Treatment Persistence.
作者信息
Giordano Antonio, Pérez-Martínez Isabel, Gisbert Javier P, Ricart Elena, Martín-Arranz María Dolores, Mesonero Francisco, Parga María Luisa De Castro, Rivero Montserrat, Iglesias Eva, Fernández-Prada Samuel, Calafat Margalida, Villarino María Teresa Arroyo, de Jorge Turrión Miguel Ángel, Hernández-Camba Alejandro, Lidón Raquel Vicente, Carpio Daniel, Brunet Eduard, Moranta Francisco Rodríguez, García Lara Arias, Cuquerella Joan Tosca, Bermejo Fernando, Madero Lucía, Esteve Maria, González-Muñoza Carlos, Martínez-Montiel Pilar, Huguet Jose M, Pérez Calle Jose Lázaro, Rodríguez-Lago Iago, Ausín Mónica Sierra, Poyatos Rufo H Lorente, García-Bosch Orlando, Marín Gerard Surís, Taxonera Carlos, Ponferrada-Diaz Ángel, Acosta Manuel Barreiro-de, Bujanda Luis, Serra Rosa Blat, Ramos Laura, Vera Isabel, Abizanda Eva Sesé, Piqueras Marta, Gómez Cristina Sánchez, García-Sepulcre Mariana Fe, Arregui Miren Vicuña, Murillo Nuria Rull, Llaó Jordina, Lucendo Alfredo J, Marín-Jiménez Ignacio, Camps-Aler Blau, Villafranca Carmen Muñoz, Ceballos Daniel, Ver Yolanda, Fernández-Salazar Luis Ignacio, Alcaín Guillermo, Valldosera Gemma, Andrés Pilar Robledo, Martínez-Flores Carlos, Coronel Ana Fuentes, Ginard Daniel, García Laura, Gómez Isabel Blázquez, Argüelles-Arias Federico, Miyashiro Eduardo Iyo, De la Piscina Patricia Ramírez, Villalba Luís Hernández, Notari Pedro Almela, de Jesús Martínez-Pérez Teresa, Fernández Hipólito, Gilabert Pau, Rosas Concepción Muñóz, Nos Pilar, Gil Jesús Legido, Navas López Víctor Manuel, Muñoz Fernando, Palomares María Teresa Diz-Lois, Lucio Ana Santos, Merino Olga, de Prado Isabel Nicolás, Leal Carles, de Carpi Javier Martín, Sánchez Lidia Buendía, Arce Nuria Maroto, Frago Santiago, Mateu Belén Botella, Domènech Eugeni, Garcia Planella Esther
机构信息
IBD Unit, Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain.
Gastroenterology Department, Hospital Universitario Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain.
出版信息
Am J Gastroenterol. 2025 Jan 1;120(1):194-203. doi: 10.14309/ajg.0000000000003207. Epub 2024 Nov 14.
INTRODUCTION
Crohn's disease (CD) varies by location, potentially affecting therapy efficacy and surgery risk, although research on this topic is conflicting. This study aims to investigate the independent association between CD location and therapeutic patterns.
METHODS
We analyzed patients with CD diagnosed from January 2005 to May 2023 registered in the nationwide ENEIDA registry. A univariate Cox regression analysis assessed the association of disease location with biologic use and persistence (with treatment discontinuation as a failure event), as well as the use of intestinal resections. A multivariate model was constructed to evaluate the independent association of disease location with therapeutic patterns, controlling for potential confounders such as sex, age at inclusion and diagnosis, disease duration and behavior, previous surgery or biological therapy, extraintestinal manifestations, and perianal disease.
RESULTS
The study included 17,292 patients with a median follow-up period of 6 years (interquartile range 2-10 years). Ileocolonic location was associated with a higher biologic use than colonic location (hazard ratio [HR] 1.30, 95% confidence interval [CI] 1.22-1.38) and ileal disease (HR 1.21, 95% CI 1.16-1.27), independently predicting biologic use (P < 0.001). Ileal location was associated with a lower biologic persistence than ileocolonic location (HR 1.14, 95% CI 1.07-1.21) and colonic disease (HR 1.10, 95% CI 1.01-1.20), independently predicting biologic persistence (P = 0.019). Ileal disease was associated with a higher likelihood of intestinal resections than colonic (HR 2.82, 95% CI 2.45-3.25) and ileocolonic location (HR 1.13, 95% CI 1.05-1.22), independently predicting the use of surgery (P < 0.001).
DISCUSSION
CD location with ileal predominance is associated with a distinct therapeutic pattern, including higher biologic use, lower treatment persistence, and increased rates of intestinal resections.
引言
克罗恩病（CD）因病变部位而异，这可能会影响治疗效果和手术风险，尽管关于这一主题的研究结果相互矛盾。本研究旨在调查CD病变部位与治疗模式之间的独立关联。
方法
我们分析了2005年1月至2023年5月在全国性ENEIDA登记处注册的CD患者。单因素Cox回归分析评估了疾病部位与生物制剂使用及持续时间（以治疗中断作为失败事件）以及肠道切除术使用之间的关联。构建了一个多变量模型来评估疾病部位与治疗模式之间的独立关联，同时控制潜在的混杂因素，如性别、纳入和诊断时的年龄、疾病持续时间和行为、既往手术或生物治疗、肠外表现以及肛周疾病。
结果
该研究纳入了17292例患者，中位随访期为6年（四分位间距为２至10年）。回结肠部位比结肠部位（风险比[HR]1.30，95%置信区间[CI]1.22-1.38）和回肠疾病（HR 1.21，95%CI 1.16-1.27）的生物制剂使用频率更高，独立预测生物制剂的使用（P<0.001）。回肠部位比回结肠部位（HR 1.14，95%CI 1.07-1.21）和结肠疾病（HR 1.10，95%CI 1.01-1.20）的生物制剂持续使用时间更短，独立预测生物制剂的持续使用（P=0.019）。回肠疾病比结肠（HR 2.82，95%CI 2.45-3.25）和回结肠部位（HR 1.13，95%CI 1.05-1.22）进行肠道切除术的可能性更高，独立预测手术的使用（P<0.001）。
讨论
以回肠为主的CD病变部位与独特的治疗模式相关，包括更高的生物制剂使用频率、更低的治疗持续时间和更高的肠道切除术发生率。
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