Changes in Disease Behaviour and Location in Patients With Crohn's Disease After Seven Years of Follow-Up: A Danish Population-based Inception Cohort
Changes in Disease Behaviour and Location in Patients With Crohn's Disease After Seven Years of Follow-Up: A Danish Population-based Inception Cohort
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DOI：
10.1093/ecco-jcc/jjx138
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发表时间：
2018-03-01
影响因子：
8
通讯作者：
Burisch, J.
中科院分区：
文献类型：
--
作者：
Lo, B.;Vester-Andersen, M. K.;Burisch, J.
背景和目的：克罗恩病[CD]是一种进行性炎症性肠病，可导致并发症，如狭窄或穿透性疾病，并最终手术。根据蒙特利尔分类，很少有基于人群的研究调查了CD疾病进展和手术的预测因素。我们的目的是确定与复杂的CD在丹麦人口为基础的初始队列在biologicalerega.Methods：所有事件的CD患者在一个明确的哥本哈根地区，2003年和2004年之间，前瞻性地随访到2011年的临床预测因素。疾病进展定义为最初诊断为非狭窄/非穿透性疾病[B1]的患者发生肠狭窄[B2]或穿透性疾病[B3]。通过考克斯回归分析研究疾病进展和/或切除与多个协变量之间的关联。共有177例[83%]患者在诊断时患有B1。改变部位的患者疾病进展风险增加（风险比[HR] = 3.1，95%CI：1.12，8.52）。生物治疗与较低的位置变化风险相关[HR = 0.3，95% CI：0.1-0.7]。结肠受累[L2或L3 vs L1]与手术风险较低相关（HR = 0.34/0.22，95% CI：[0.13，0.86]/[0.08，0.60]）。所有行为进展或改变部位的CD患者手术风险增加[p < 0.05]结论：这项基于人群的初始队列研究表明，CD患者疾病部位或行为的变化增加了切除的风险。我们的研究结果强调了生物治疗对疾病部位改变的保护作用，这可能最终改善CD患者的病程。
Background and Aim: Crohn's disease [CD] is a progressive inflammatory bowel disease that can lead to complications such as strictures or penetrating disease, and ultimately surgery. Few population-based studies have investigated the predictors for disease progression and surgery in CD according to the Montreal classification. We aimed to identify clinical predictors associated with complicated CD in a Danish population-based inception cohort during the biologic era.Methods: All incident patients with CD in a well-defined Copenhagen area, between 2003 and 2004, were followed prospectively until 2011. Disease progression was defined as the development of bowel stricture [B2] or penetrating disease [B3] in patients initially diagnosed with non-stricturing/non-penetrating disease [B1]. Associations between disease progression and/or resection, and multiple covariates, were investigated by Cox regression analyses.Results: In total, 213 CD patients were followed. A total of 177 [83%] patients had B1 at diagnosis. Patients who changed location had increased risk of disease progression (hazard ratio [HR] = 3.1, 95% CI: 1.12,8.52). Biologic treatment was associated with lower risk of change in location [HR = 0.3, 95% CI: 0.1-0.7]. Colonic involvement [L2 or L3 vs L1] was associated with a lower risk of surgery (HR = 0.34/0.22, 95% CI: [0.13,0.86]/[0.08,0.60]). All CD patients who progressed in behaviour or changed location had an increased risk of surgery [p < 0.05]Conclusions: This population-based inception cohort study demonstrates that changes in disease location or behaviour in patients with CD increase their risk of resection. Our findings highlight the protective effect of biologic treatment with regard to change in disease location, which might ultimately improve the disease course for CD patients.