Shivananda S, Lennard-Jones J, Logan R, Fear N, Price A, Carpenter L, van Blankenstein M
Department of Internal Medicine, University Hospital, Maastricht, The Netherlands.
Gut. 1996 Nov;39(5):690-7. doi: 10.1136/gut.39.5.690.
It has been suggested that the incidence of inflammatory bowel disease (IBD), which includes ulcerative colitis (UC) and Crohn's disease (CD), is three or more times higher in northern than in southern Europe. The aim of this EC funded study was to investigate this apparent variation by ascertaining the incidence of IBD across Europe.
For the period 1 October 1991 to 30 September 1993 all new patients diagnosed with IBD were prospectively identified in 20 European centres according to a standard protocol for case ascertainment and definition.
Altogether 2201 patients aged 15 years or more were identified, of whom 1379 were diagnosed as UC (including proctitis), 706 as CD, and 116 as indeterminate. The overall incidence per 100,000 at ages 15-64 years (standardised for age and sex) of UC was 10.4 (95% confidence interval (95% CI) 7.6 to 13.1) and that of CD was 5.6 (95% CI 2.8 to 8.3). Rates of UC in northern centres were 40% higher than those in the south (rate ratio (RR) = 1.4 (95% CI 1.2 to 1.5)) and for CD they were 80% higher (RR = 1.8 (95% CI 1.5 to 2.1)). For UC the highest reported incidence was in Iceland (24.5, 95% CI 17.4 to 31.5) and for CD, Maastricht (The Netherlands; 9.2, 95% CI 6.5 to 11.8) and Amiens (north west France; 9.2, 95% CI 6.3 to 12.2). The lowest incidence of UC was in Almada (southern Portugal) (1.6, 95% CI 0.0 to 3.2) and of CD in Ioannina (north west Greece) (0.9, 95% CI 0.0 to 2.2). An unexpected finding was a difference in the age specific incidence of UC in men and women with the incidence in women but not men declining with age.
The higher overall incidence rates in northern centres did not seem to be explained by differences in tobacco consumption or education. Nevertheless, the magnitude of the observed excess for both conditions is less than expected on the basis of previous studies. This may reflect recent increases in the incidence of IBD in southern Europe whereas those in the north may have stabilised.
有人提出，包括溃疡性结肠炎（UC）和克罗恩病（CD）在内的炎症性肠病（IBD）在北欧的发病率比南欧高三倍或更多。这项由欧盟资助的研究旨在通过确定全欧洲IBD的发病率来调查这一明显差异。
在1991年10月1日至1993年9月30日期间，按照病例确定和定义的标准方案，在20个欧洲中心前瞻性地识别所有新诊断为IBD的患者。
共识别出2201名15岁及以上的患者，其中1379例被诊断为UC（包括直肠炎），706例为CD，116例为不确定型。15 - 64岁（年龄和性别标准化）UC的总体发病率为每10万人10.4（95%置信区间（95%CI）7.6至13.1），CD为5.6（95%CI 2.8至8.3）。北部中心的UC发病率比南部高40%（发病率比（RR）= 1.4（95%CI 1.2至1.5）），CD则高80%（RR = 1.8（95%CI 1.5至2.1））。UC报告发病率最高的是冰岛（24.5，95%CI 17.4至31.5），CD是马斯特里赫特（荷兰；9.2，95%CI 6.5至11.8）和亚眠（法国西北部；9.2，95%CI 6.3至12.2）。UC发病率最低的是阿尔马达（葡萄牙南部）（1.6，95%CI 0.0至3.2），CD最低的是约阿尼纳（希腊西北部）（0.9，95%CI 0.0至2.2）。一个意外发现是，UC在男性和女性中的年龄特异性发病率存在差异，女性而非男性的发病率随年龄下降。
北部中心总体发病率较高似乎无法用烟草消费或教育程度的差异来解释。然而，两种疾病观察到的超额发病率幅度低于先前研究预期。这可能反映了南欧IBD发病率近期上升，而北欧可能已趋于稳定。
