Changes in disease behaviour and location and factor analysis in patients with Crohn’s disease undergoing repeated-resections
Changes in disease behaviour and location and factor analysis in patients with Crohn’s disease undergoing repeated-resections
复制标题
克罗恩病多次切除患者疾病行为、部位变化及因素分析
DOI：
10.1097/meg.0000000000002145
复制
发表时间：
2021
影响因子：
2.1
通讯作者：
Weiming Zhu
中科院分区：
文献类型：
--
作者：
Tao Li;Lei Gao;Lei Cao;Zhen Guo;Wenwei Qian;Yi Yin;Yi Li;Weiming Zhu
补充数字内容可在文本中找到。目的克罗恩病影响整个胃肠道，并伴有疾病部位和行为的改变。目的分析克罗恩病患者重复肠切除术后的变化及其影响因素。方法我们纳入并回顾性分析了2008年1月至2019年12月在三级炎症性肠病中心接受≥2次肠道手术的克罗恩病患者。蒙特利尔分类用于描述疾病部位和行为。因素分析采用单因素和多因素分析。结果共纳入339例患者，其中94例患者接受了≥3次肠切除术。第二次和第三次手术时患者的中位年龄分别为36.4岁和39.6岁。重复切除最常发生在原手术部位。然而，疾病行为的进展与手术干预的数量和疾病的持续时间，特别是对于B1表型的患者。初次切除时患有L1克罗恩病的患者在第二次手术切除时进展为L2克罗恩病，需要比疾病仍在L1或进展为L3克罗恩病的患者更早切除。多变量分析显示，阑尾切除术史是第二次手术切除时克罗恩病从L1进展至L3的预测因素，而硫唑嘌呤（AZA）治疗可能是降低克罗恩病从L1进展至L3风险的保护因素。结论克罗恩病患者的复发部位以原切除部位最常见，但随着手术次数和病程的增加，疾病行为也会逐渐加重。有阑尾切除术史的L1克罗恩病患者在第二次手术切除时进展为L3克罗恩病的风险较高，而AZA可能是降低L1进展为L3风险的保护因素。
Supplemental Digital Content is available in the text. Aim Crohn’s disease affects the entire gastrointestinal tract and is accompanied by changes in disease location and behaviour. We aimed to analyse changes and the factors in patients with Crohn’s disease undergoing intestinal repeated-resection. Methods We included and retrospectively analyzed patients with Crohn’s disease who received ≥2 bowel surgeries from a tertiary inflammatory bowel disease centre from January 2008 to December 2019. The Montreal classification was used to describe the disease site and behaviour. Factors were assessed by univariate and multivariate analysis. Results A total of 339 patients were included of whom 94 patients received ≥3 bowel resections. The median patient’s age at the second and third surgery was 36.4 and 39.6, respectively. Repeated-resection most commonly occurred in the original surgical site. However, disease behaviour progressed with the number of surgical interventions and disease duration, especially for patients with B1 phenotype. Patients with L1 Crohn’s disease at a primary resection that progressed to L2 Crohn’s disease at a second surgical resection required a resection earlier than patients whose disease remained in L1 or progressed to L3 Crohn’s disease. Multivariate analysis showed that history of appendectomy was a predictor of progression from L1 to L3 Crohn’s disease at a second surgical resection, while treatment with azathioprine (AZA) may be a protective factor that abated the risk of progression from L1 to L3 Crohn’s disease. Conclusion The original resection site is the most common location for recurrence in patients with Crohn’s disease, but disease behaviour progresses with the number of surgeries and disease duration. L1 Crohn’s disease patients with a history of appendectomy have a higher risk to progress to L3 Crohn’s disease at a second surgical resection, while the AZA may be a protective factor that reduces the risk of progression from L1 to L3.
影响因子：
29.4
作者：
Thia KT;Sandborn WJ;Harmsen WS;Zinsmeister AR;Loftus EV Jr
通讯作者：
Loftus EV Jr
影响因子：
3.8
作者：
Frisch, M;Johansen, C;Olsen, JH
通讯作者：
Olsen, JH