Changes in Crohn's disease phenotype over time in the chinese population: Validation of the Montreal classification system
Changes in Crohn's disease phenotype over time in the chinese population: Validation of the Montreal classification system
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DOI：
10.1002/ibd.20335
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发表时间：
2008-04-01
影响因子：
4.9
通讯作者：
Sung, Joseph J. Y.
中科院分区：
文献类型：
--
作者：
Chow, Dorothy K. L.;Leong, Rupert W. L.;Sung, Joseph J. Y.
背景：克罗恩病的表型进化发生在白人中，但从未在其他人群中描述过。蒙特利尔分类可能更准确地描述表型。本研究的目的是通过与维也纳分类相比的纵向敏感性分析来验证蒙特利尔分类在检测表型变异方面的有效性。方法：对连续的中国克罗恩病患者进行回顾性纵向研究。所有病例根据行为和地点按蒙特利尔分类和维也纳分类进行分类。评估了这些特征的演变和手术的必要性。结果：共纳入109例患者（中位随访4年，范围6个月-18年）。克罗恩病行为在诊断后3年发生改变（P=0.025），根据蒙特利尔分类，狭窄型和穿透型表型增加。但5年后才被维也纳分类发现（P=0.015）。两种分类的疾病位置在随访中保持稳定。34例患者（31%）在随访期间接受了大手术，并发狭窄[P= 0.002；风险比（HR）： 3.3；95% CI: 1.5-7.0]和穿透性（P = 0.03; HR: 5.8; 95% CI: 1.2-28.2）表型根据蒙特利尔分类与需要大手术相关。结肠疾病对大手术有保护作用（P = 0.02; HR: 0.3; 95% CI: 0.08-0.8）。结论：这是首次在非白人人群中证明克罗恩病表型进化的研究。在将肛周疾病从穿透性疾病类别中排除后，蒙特利尔分类比维也纳分类对行为表型变化更敏感，并且在预测病程和手术需求方面有用。
Background: Phenotypic evolution of Crohn's disease occurs in whites but has never been described in other populations. The Montreal classification may describe phenotypes more precisely. The aim of this study was to validate the Montreal classification through a longitudinal sensitivity analysis in detecting phenotypic variation compared to the Vienna classification.Methods: This was a retrospective longitudinal study of consecutive Chinese Crohn's disease patients. All cases were classified by the Montreal classification and the Vienna classification for behavior and location. The evolution of these characteristics and the need for surgery were evaluated.Results: A total of 109 patients were recruited (median follow-up: 4 years, range: 6 months-18 years). Crohn's disease behavior changed 3 years after diagnosis (P=0.025), with an increase in stricturing and penetrating phenotypes, as determined by the Montreal classification. but was only detected by the Vienna classification after 5 years (P=0.015). Disease location remained stable on follow-up in both classifications. Thirty-four patients (31%) underwent major surgery during the follow-up period with the stricturing [P= 0.002; hazard ratio (HR): 3.3; 95% CI: 1.5-7.0] and penetrating (P = 0.03; HR: 5.8; 95% CI: 1.2-28.2) phenotypes according to the Montreal classification associated with the need for major surgery In contrast. colonic disease was protective against a major operation (P = 0.02: HR: 0.3; 95% CI: 0.08-0.8).Conclusions: This is the first study demonstrating phenotypic evolution of Crohn's disease in a nonwhite population. The Montreal classification is more sensitive to behavior phenotypic changes than is the Vienna classification after excluding perianal disease from the penetrating disease category and was useful in predicting course and the need for surgery.