Palli D, Trallori G, Saieva C, Tarantino O, Edili E, D'Albasio G, Pacini F, Masala G
Sez. Epidemiologia Analitica, U.O. Epidemiologia, CSPO, Florence, Italy.
Gut. 1998 Feb;42(2):175-9. doi: 10.1136/gut.42.2.175.
A population based epidemiological study identified all the patients diagnosed with ulcerative colitis (UC) or Crohn's disease (CD) resident in the Florence area in the period 1978-1992.
To assess the mortality of unselected patients with inflammatory bowel disease (IBD) in a Mediterranean country.
Overall, 920 patients (689 UC and 231 CD) were followed until death or end of follow up (31 December 1996). Information on vital status was available for all except eight patients (0.9%); 70 deaths were identified (23 in patients with CD and 47 in patients with UC). Expected deaths were estimated on the basis of five year age group, gender, and calendar year national mortality rates. Standardised mortality ratios (SMR) and 95% confidence intervals were calculated.
General mortality was significantly lower than expected in UC (SMR 0.6; 95% confidence interval 0.4 to 0.8), due to a reduced number of cardiovascular and, possibly, smoking related deaths. Cancers of the respiratory tract were significantly reduced in UC but tended to be increased in patients with CD. These latter patients had not only an increased cancer mortality but also a 40% increased risk of dying for all causes already evident in the first five year follow up period and persisting thereafter. In contrast, in patients with UC, SMRs were initially very low but tended to increase steadily over the follow up period. Gastrointestinal deaths were particularly increased in patients with CD, but only moderately in those with UC. Overall, there was some evidence of a twofold increased mortality for colorectal cancer, the risk being highest for rectal cancers in patients with UC. A non-significant excess of deaths due to haemolymphopoietic malignancies and suicides was also observed.
This study, the first in a Mediterranean country, supports the existence of two divergent mortality patterns for patients with UC and CD, possibly explained by differences in smoking habits and by a greater severity of CD.
一项基于人群的流行病学研究确定了1978年至1992年期间居住在佛罗伦萨地区所有被诊断为溃疡性结肠炎（UC）或克罗恩病（CD）的患者。
评估一个地中海国家中未经挑选的炎症性肠病（IBD）患者的死亡率。
总体而言，对920例患者（689例UC和231例CD）进行随访直至死亡或随访结束（1996年12月31日）。除8例患者（0.9%）外，所有患者的生命状态信息均可用；共确定70例死亡（CD患者23例，UC患者47例）。根据五岁年龄组、性别和历年全国死亡率估计预期死亡数。计算标准化死亡率（SMR）和95%置信区间。
UC患者的总体死亡率显著低于预期（SMR 0.6；95%置信区间0.4至0.8），原因是心血管疾病死亡人数减少，可能还有与吸烟相关的死亡人数减少。UC患者呼吸道癌症显著减少，但CD患者呼吸道癌症有增加趋势。后者不仅癌症死亡率增加，而且在最初的五年随访期内所有原因导致的死亡风险就已增加40%，且此后一直持续。相比之下，UC患者的SMR最初非常低，但在随访期间趋于稳步上升。CD患者胃肠道死亡尤其增加，但UC患者仅中度增加。总体而言，有证据表明结直肠癌死亡率增加了两倍，UC患者直肠癌的风险最高。还观察到血液系统恶性肿瘤和自杀导致的死亡略有增加。
这项在地中海国家进行的首次研究支持UC和CD患者存在两种不同的死亡模式，这可能由吸烟习惯的差异和CD病情更严重来解释。
