Inflammation is an independent risk factor for colonic neoplasia in patients with ulcerative colitis: a case-control study.
Inflammation is an independent risk factor for colonic neoplasia in patients with ulcerative colitis: a case-control study.
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DOI：
10.1016/j.cgh.2013.06.023
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发表时间：
2013-12
影响因子：
12.6
通讯作者：
Turner, Jerrold R.
中科院分区：
文献类型：
--
作者：
Rubin, David T.;Huo, Dezheng;Kinnucan, Jami A.;Sedrak, Mina S.;McCullom, Nicole E.;Bunnag, Alana P.;Raun-Royer, Elin P.;Cohen, Russell D.;Hanauer, Stephen B.;Hart, John;Turner, Jerrold R.
溃疡性结肠炎（UC）患者的炎症活动与结直肠肿瘤（CRN）之间存在关联。然而，以前的研究没有解决炎症持续时间或治疗对CRN风险的影响。我们调查了UC患者的炎症、治疗和特征对其CRN风险的影响。我们收集了141例无CRN的UC患者（对照组）和59例伴有CRN的UC患者（病例）的数据，比较了疾病的程度、持续时间和患者的年龄。我们使用新的6点组织学炎症活动（HIA）量表对活检片段进行评分（n=4449）。从芝加哥大学炎症性肠病内窥镜数据库中收集药物、吸烟状况、原发性硬化性胆管炎（PSC）和CRN家族史的信息。通过条件逻辑回归评估HIA、临床特征和CRN之间的关系。病例和对照组在手术和活检次数、类固醇或美沙拉明暴露、吸烟状况和CRN家族史方面相似。他们在男女比例、免疫调节剂暴露和PSC患病率方面存在差异。在单因素分析中，HIA与CRN呈正相关（优势比[OR]， 2.56/ /单位增加；P=.001），而免疫调节剂（包括硫唑嘌呤、6-巯基嘌呤和甲氨蝶呤）降低CRN的风险（OR, 0.35； P<.01）。在多变量分析中，HIA也与CRN相关（OR, 3.68； P=.001）。在一项病例对照研究中，我们将UC患者的炎症增加与CRN联系起来。使用免疫调节剂降低了CRN的风险，表明这些药物具有化学保护作用。基于这些数据，我们提出了新的分层监测和治疗策略，以预防和检测UC患者的CRN。
An association between inflammatory activity and colorectal neoplasia (CRN) has been documented in patients with ulcerative colitis (UC). However, previous studies did not address the duration of inflammation or the effects of therapy on risk for CRN. We investigated the effects of inflammation, therapies, and characteristics of patients with UC on their risk for CRN. We collected data from 141 patients with UC without CRN (controls), and 59 matched patients with UC who developed CRN (cases), comparing disease extent and duration and patients’ ages. We used a new 6-point histologic inflammatory activity (HIA) scale to score biopsy fragments (n=4449). Information on medications, smoking status, primary sclerosing cholangitis (PSC), and family history of CRN were collected from the University of Chicago Inflammatory Bowel Disease Endoscopy Database. Relationships between HIA, clinical features, and CRN were assessed by conditional logistic regression. Cases and controls were similar in numbers of procedures and biopsies, exposure to steroids or mesalamine, smoking status, and family history of CRN. They differed in proportion of men vs women, exposure to immune modulators, and PSC prevalence. In univariate analysis, HIA was positively associated with CRN (odds ratio [OR], 2.56/ per unit increase; P=.001), whereas immune modulators (including azathioprine, 6-mercaptopurine, and methotrexate) reduced the risk for CRN (OR, 0.35; P<.01). HIA was also associated with CRN in multivariate analysis (OR, 3.68; P=.001). In a case–control study, we associated increased inflammation with CRN in patients with UC. Use of immune modulators reduced the risk for CRN, indicating that these drugs have chemoprotective effects. Based on these data, we propose new stratified surveillance and treatment strategies to prevent and detect CRN in patients with UC.
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影响因子：
168.9
作者：
CONNELL, WR;KAMM, MA;LENNARDJONES, JE
通讯作者：
LENNARDJONES, JE
影响因子：
29.4
作者：
Gupta, Roopali Bansal;Harpaz, Noam;Ullman, Thomas
通讯作者：
Ullman, Thomas
影响因子：
1.9
作者：
LANDIS, JR;KOCH, GG
通讯作者：
KOCH, GG
影响因子：
9.8
作者：
Bernstein, Charles N.;Nugent, Zoann;Blanchard, James F.
通讯作者：
Blanchard, James F.
影响因子：
15.9
作者：
Popivanova, Boryana K.;Kitamura, Kazuya;Mukaida, Naofumi
通讯作者：
Mukaida, Naofumi